Cancer test wait times: GPs and consultants respond

Doctors agree that waiting times for X-rays, scans and other cancer tests can be long, but just how bad the situation is seems to depend on where in the health system you are working.

To GPs, the system is ad hoc, haphazard, plagued by delays and almost certainly the cause of patient deaths. Consultants, in contrast, stress the positive aspects, notably the relative speed most urgent cases are dealt with.

Galway city GP Brian Osborne says the system isn't geared to work correctly because well-trained GPs are still dependent on hospitals to get diagnostics for patients.

While rapid-access clinics for breast, lung, prostate and melanoma cancers work well, access to tests for other cancers remains “haphazard”.

“People have died waiting for investigations,” he says. “Early detection leads to better outcomes and also costs less.”

He says GPs often face a dilemma when a patient presents with undifferentiated symptoms such as bloating and access to tests is limited. “Do you clog up the hospital system by sending the person to outpatients or do you wait?”

In outpatients, the patient will be seen by a junior doctor, effectively repeating the work done by the GP. The patient will have to come back for a second appointment for the results, thereby further duplicating the work involved.

Immediate attention

Brain surgeon Donncha O’Brien, chairman of the neurosurgery department at

Beaumont Hospital

, says that despite the long waiting lists, urgent referrals will always get the immediate attention they deserve.

“People don’t need to stand on ceremony and there’s no need for anyone to be waiting for months. If someone rings us about a scan, they’ll be treated with the utmost respect.”

Not all requests come in with specific details about symptoms and this may play a part in longer processing times, he says. Beaumont has recently moved to an electronic referral system which should help improve matters, he adds.

Edel McGinnity is a GP in Mulhuddart, Co Dublin, and her catchment area has some of the highest rates of cancer in the State. “The big problem is not the definite cancers. It’s the ‘inbetween’ cases you’re not too sure about; the tummy pain that could turn out to be pancreatic cancer or the bloating that may be ovarian cancer.”

Doctors can’t go to consultants saying, “I think this one is cancer” every time or they would never have a test carried out, she says.

McGinnity says there has been a “huge improvement” in the waiting lists for ultrasound, down from 11 months to five over the past year.

However, waiting times for colonoscopies in Beaumont Hospital currently stand at one year. “You can’t spend your life on the phone seeking dates for a test, but you do. The system shouldn’t have to rely on individual GPs ringing up.”

Improvement

Prof

Hugh Mulcahy

, a gastroenterologist at St Vincent’s Hospital, says he is pleasantly surprised by the improvement in standards evident over the past five years. While waiting times for public patients for endoscopies were clearly too long – 59 days versus 10 days for private patients – they are getting shorter.

In addition, he says, as the public waiting list includes both urgent and non-urgent cases, the bulk of the delay is attributable to the non-urgent cases.

St Vincent’s is required under its accreditation to test urgent cases within four weeks and other cases within 13 weeks, he says.

Waiting times could be shortened by increasing capacity in the public system and by introducing electronic referrals so time is not wasted sending letters to and fro, he suggests.