2023 | Volume 24 | Issue 4
Disparities in surgical outcomes are multi factorial and these include ethnicity, other demographics, resource constraints, and variations in the accessibility of surgical expertise, due to the ‘postcode lottery’ (means people who live in more remote locations may be disadvantaged by having limited access to specialist care, facilities, or resources). They may also need to travel away from home for their care.
Much of healthcare now relies on input from the wider team, with wrap around services including specialist nurses. These often only exist in tertiary centres with higher volumes. This team approach can result in better patient outcomes. Although these outcomes can be the result of many factors (not just the surgeon) it is sometimes used as a justification for the greater centralisation of services.
However, this is not always the best solution for these patients and is often highly inconvenient and disruptive for them and their whānau and expensive for the community. Often patients in rural areas will choose different treatment options that can be provided locally and reduce the burden of their travel. This may include requesting a mastectomy rather than opting for a breast conserving surgery that requires radiotherapy.
Variable outcomes according to location are often compared from the perspective of a smaller specialty that is mainly represented in the tertiary hospitals. For many common conditions the results of surgery are highly dependent on patient location. This is used as an argument for centralisation. One could argue instead that the central specialists have an obligation to provide greater support to the regional centres, and if this means the inconvenience of providing an outreach service, then this is what is needed. It might also mean upskilling local surgeons and a closer rapport between the metropolitan and rural surgeons.
Smaller specialities can drain a large geographical catchment area but have a range of service configurations. It would be useful to audit both major and minor surgeries for their specialty services across their whole catchment area as this will expose where some of their patients may be disadvantaged because of their location.
As a profession we cannot wait for our lawmakers and health ministries to come up with all the answers to reduce inequity related to location. Instead, there are things we can do, even if they involve the discomfort of moving from a convenient health provider focus to a more patient focussed emphasis where we go to the patient rather than then coming to us.