AMA Tasmania’s president says category 3 outpatients may never reach the front of the queue.
Transparency is the first step, but outpatient care will require “practical redesign” and investment, said AMA Tasmania president Dr Meg Creely this week.
Under the Tasmanian Department of Health’s definition, category three patients are those unlikely to deteriorate quickly or require more complex care if their care is delayed beyond 365 days but should ideally be seen within that period.
Dr Creely, a GP in Lauderdale, told The Medical Republic that she and several other colleagues had noticed the waiting lists growing longer in recent years.
“Their category 3 or non-urgent wait list is getting so long that there’s this general sense, both amongst the doctors and amongst hospital management, that those patients are never going to get seen because of the volume of people,” Dr Creely said.
“Being told you are ‘on a waiting list’ makes people believe their turn will come. If that is not realistic, patients deserve to know so they can make decisions about their care,” she wrote in a statement on Wednesday.
AMA Tasmania was not able to provide specific examples of patients deteriorating or dying, she told TMR, because those patients often returned to their GP for an updated referral and were bumped up to a higher urgency category.
But there were examples of patients awaiting their biopsy results for six to 12 weeks, with the results still unavailable.
Another patient had an MRI, but by the time she was reviewed nine months later, the imaging was deemed “almost useless” because the disease had progressed significantly, Dr Creely said.
According to Tasmanian government data, the longest estimated waits for category 3 patients are in neurology outpatient clinics, at more than five and a half years.
Ear, nose and throat clinics follow at 1979 days, with respiratory at 1920 days.
“Patients can deteriorate, pain can become chronic, conditions can become harder to treat, and some harm cannot be undone,” she said.
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Outpatient lists also conceal a hidden bottleneck, where patients cannot be added to a surgery list until they have seen a surgeon, her statement read.
“As a GP, I sit with these patients … what does it say about our system when doctors are discussing whether a patient should try to find care somewhere else?
“When we have to discuss taking out private health insurance because the wait for pre-existing conditions is often shorter than the wait for outpatient services? Or how much it will cost to travel interstate for the care they need?”
Dr Creely called for a model similar to Mater Queensland’s eConsultant, which connects GPs directly with hospital medical specialists to fast-track clinical advice for patients.
Alternatively, models of care that would allow GPs to provide clinical review, escalation and planning while patients remain on waiting lists.
“What we’d really like to see is that clinician voice be brought back into how hospitals are run,” she said.
Dr Creely also called for more honest conversations about what can and cannot be delivered.
While additional investment was necessary, she urged for a larger specialist workforce, improved multidisciplinary care, advanced technological systems, improved referral and booking processes, and more timely diagnostics and assessments to prevent wasted appointments.
Tasmania may have the highest rates for many chronic diseases, Dr Creely said, but the state’s struggles were also not “horribly unique”.
“We sometimes see dermatology specifically list the things that they don’t see. But I don’t think I’ve seen any health department yet come out and say, ‘Actually the wait list is so long we will never realistically get to those category 3s unless we change something’.
“I’ve seen the Department of Health’s response around ‘we’re delivering more outpatient care’. But, from year to year, does that match the demand? What is the demand?
“Just saying we deliver more care isn’t enough without knowing how much is needed,” she told TMR.
“None of this should be accepted as normal. A system under pressure can still learn, improve and act when patients are being left behind.”
