The question
Three years ago, my husband was referred to a specialist to operate on his ankle. His doctor's office can tell us only that they did send the referral, but he still doesn't even have a consultation booked. The receptionist at the specialist never answers the phone. We are very polite and we understand that there are wait lists and probably people with worse problems, but we don't even know if we are in the queue. How should we proceed?
The answer
I'm sorry to hear that it has taken so long for your husband to see a specialist. Despite long wait lists in Canada for specialists, waiting three years for a first appointment is simply unacceptable. It sounds like you've patiently tried to clarify the situation by contacting both your family doctor and the specialist's office, but it hasn't resulted in any answers. I understand your frustration and I'm concerned that something has fallen through the cracks.
The Fraser Institute published a study looking at wait times in Canada in December, 2011. They found that the average wait time from referral from a family doctor to seeing a specialist was 9.5 weeks. There was variation between provinces, with Ontario having the shortest wait times of 7.2 weeks and PEI having the longest of 31.6 weeks. The type of specialist you are waiting for can also affect your time, with plastic surgery and orthopedic surgery having longer waits than other specialties.
There may have been delays in your referral for a number of reasons. As you mention, referrals are triaged or prioritized based on urgency or severity of the condition. If your condition is considered non-urgent, more severe cases may be put ahead in the queue.
Where you live can also affect how quickly you'll be seen by a specialist. In rural settings, and increasingly in urban ones, the list of potential specialists can be limited and that results in longer wait times. In these cases, your doctor can look to neighbouring areas or larger urban centres that may need you to travel, but may offer earlier appointment times.
If the surgeon read the consultation letter and felt that the referral was inappropriate, he may not see a patient. The specialist will usually write back to the referring doctor and specify that a new referral to a different specialist should be made – your family doctor must have been aware of this.
Regardless, these reasons alone are not enough to explain a three-year waiting time. So here are my suggestions:
First, you need to return to your family doctor's office and request specific details on whether or not they have received acknowledgment from the specialist's office that they received the initial referral. If they have not received notification, your family doctor could refer you back to the same specialist or an alternative one. Given your situation, you shouldn't hesitate to ask your doctor to call them directly, or have their receptionist call on your behalf to clarify what has happened.
In some provinces, another option may be a centralized joint-assessment centre that sees patients in a more timely way. While this may mean restarting the process, it may result in a faster appointment than your current situation.
Alternatively, some of my patients have gone to a specialist's office in person and spoken to the receptionist directly to get an appointment, or to see if they can be put on a cancellation list. But given that you have tried to contact them already, this may not be realistic for you.
Your family doctor should be there to advocate for you and assist in finding timely care. When I make a referral, I ask that my patients call our office after a month if they have not heard back regarding their appointment, so that we can follow up. Many referrals are made every day and patients can get lost in the system, so this is one way I try to safeguard against this. Our health-care system depends upon proper communication, and unfortunately patients can be left out of that loop. Highlighting situations like yours can only increase doctors' awareness of unacceptably long wait times, and bring our patients back into the circle of communication so that they get timely care.
Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.
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