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Editorial: Let doctors, not politicians, decide on patient care

Physicians traditionally decide on which patients to admit to hospital and what treatments they receive
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A doctor checks a patient's scans during surgery. Barbara Ries, UCSF via AP

It’s becoming increasingly difficult to know who is calling the shots on surgery postponements.

In December, Health Minister Adrian Dix announced that “elective” surgeries would be ­cancelled in preparation for the anticipated upswing in COVID cases.

Last week at least 530 “non-urgent” surgeries were cancelled across the province.

That would appear to put Dix firmly in the driver’s seat, along with the provincial health officer, Dr. Bonnie Henry, who has also advocated surgery deferrals.

If the health minister had warned hospitals that an influx of COVID patients may be coming, and to prepare for that with all available resources, he would have acted appropriately.

He could have offered additional funding. That too would have fallen within his purview.

But by going a step further, and calling for surgical deferrals, he comes close to violating a longstanding principle that governs hospital care in our province.

Traditionally, the decision on which patients to admit to hospital and the treatment they receive rests with the attending doctor or specialist.

In part, this reflects the fact that only trained physicians have the knowledge and expertise to make such an important decision.

It is also based on the reality that health-care systems are large and complex. Patients can ­easily get lost in them.

We guard against that by making doctors the advocate for their patients. It is their job to steer their patients through the system and ensure they get the care they need.

That is how we protect the rights of individual patients to the best care possible.

This is not to say that physicians can have all the resources they want. There are at all times funding limitations, and within those, doctors do their best.

But by specifying a halt on elective surgeries, the government came close to taking medical decisions out of the hands of those solely qualified to make them, namely doctors.

Then there is the question of what counts as an “elective” procedure. In Ontario and Quebec, where surgeries have also been cancelled, we learn that patients requiring cancer operations are among those whose procedures have been deemed elective.

In one well-reported case, a woman who required a full mastectomy, and who had already waited some time for her surgery, was told at the last minute that the operation was off. Her ­physician had no say in the matter.

Eventually, after a delay of 10 weeks, the surgery proceeded. This is not in any sense patient care. It comes very close to patient don’t-care.

So could this happen here? This is what we know so far.

The Health Ministry defines “urgent” cases as adult patients with a wait time of six weeks or less. So conceivably a cancer patient could wait six weeks for surgery under the new regime.

However, the ministry also concedes that some cancer patients awaiting surgery might not be considered urgent. Their wait could be longer.

This is deeply troubling. It’s difficult to ­conceive of a circumstance where a diagnosis of cancer would not be considered urgent.

Certainly from the patient’s perspective, that would be stomach-churning.

We all accept the reality that when resources are stretched, as they may be with the new Omicron variant, tough choices must be made.

But it matters very much who makes them. This is not something a politician, no matter how well intended, should be doing.

This week Dix backed away from the overly directive role he had assumed. Speaking to the media, he stated: “The decisions about surgical postponements or changes or when surgeries take place are decisions made by doctors.”

That’s as it should be.

It remains to be seen how much pressure the Omicron strain will place on our hospitals. With luck, the symptoms will be mild and the crisis soon over.

But while it lasts, it’s important that our ­government officials get their messaging straight. Doctors are in charge of patient care, not ­politicians.