In order to perform basic medical tests, including pregnancy tests, doctors and nurses working for Quebec’s CISSSs and CIUSSSs must now receive special training. On site, this new administrative barrier is annoying.
Posted at 5:00 am
Lila Dussault The Press
“It’s not complicated: we take the strip, we put it in the urine and we look at the colors,” explains Dr. Etienne Villeneuve, doctor in a university group for family medicine (GMF-U) of Lanaudiere. “Pregnancy tests, pregnant women buy them from Dollarama and they can analyze them! »
dr Villeneuve has been working in this GMF-U for more than 10 years, accompanying pregnant women in particular. For at least a year, a new national standard has been in force for a number of simple tests (pregnancy, urinary tract infection, streptococcus, etc.), some of which can even be carried out in pharmacies.
This is due in particular to the use of OPTILAB, a grouping of different medical-biological laboratories which, according to the MSSS, are divided into 12 “Clusters of Services”. This reorganization, which began in 2011, requires laboratories for outsourced medical biological testing (outside the laboratory) to obtain accreditation from the International Organization for Standardization (ISO).
The conditions of this approval include: Recurring employee training.
As a result, these very simple tests must now be sent to the lab instead of being performed in the doctor’s office. Or they can be performed on-site by nurses or doctors if they have received specific annual training of one hour per test type.
Something that, according to Dr. Villeneuve feels like a waste of time. “Two or three hours of training [par année] and per employee, doctor or nurse, that’s a lot of hours that aren’t available to patients,” he emphasizes.
for dr Mathieu Moreau, a general practitioner specializing in palliative care, “any additional compulsory training discourages professionals, especially doctors.” In his view, doctors risk not doing the tests and diverting patients elsewhere.
“#Optilab #Opticrap is very happy to be eager to quality control tests that my mother could do with her eyes closed,” said Dr. Sébastien Poulin, doctor specializing in medical microbiology and infectiology at the CISSS des Laurentides, on Twitter. He responded to a publication on the subject by Dr. Villeneuve on August 15th.
Not all doctors
The problem is that this new standard only regulates doctors who work “in the facilities” of the Department of Health and Social Care – such as the CISSS de Lanaudière, which reports to the GMF-U, where Dr. Villeneuve.
Other primary care clinics can therefore continue to use these tests as usual without training.
At the clinic where Dr. Villeneuve practiced, all nurses were initially trained. But with the pandemic, load shedding and staff mobility, Dr. Villeneuve send samples to the laboratory due to lack of trained staff.
“This leads to additional costs and delays in diagnostics,” he says. And it’s worse for urgent situations: a patient who wants an IUD inserted (preliminary pregnancy test is required) or another who needs antibiotics because of possible strep throat.
Sometimes it takes days to wait before getting an answer from the lab, says Dr. Villeneuve, whereas earlier the result was instantaneous. And in some cases, patients even choose to take the test at the pharmacy at their own expense and come back with the result.
A few days ago, the doctor finally decided to do the desired training himself. As he left angrily, he wryly tweeted: “For 1 year now, CISSS/optilab has banned me from performing pregnancy testing and urinalysis in my office because they cannot guarantee the reliability of my technique/interpretation. […] Today I passed my 2 written (yes yes, answer options) and practical exam! I’m good for a year! Recertification in one year! I feel really well prepared now! »
The Order of Nurses of Quebec told La Presse that it has not received any complaints in this regard.
A provincial standard
This standard was introduced “to improve the quality of service provided by medical biology laboratories,” says Robert Maranda, director of media relations for the Department of Health and Human Services (MSSS).
“The standard includes training, certification and recertification for pregnancy tests, among other things,” confirms Mr. Maranda. Medical-biological examinations may only be carried out by trained personnel who have demonstrated their skills. »
“Accreditation of laboratories to this standard is a requirement of the MSSS, which has mandated the Bureau de Normalization du Québec (BNQ) to ensure provincial-level evaluation of laboratories,” the communications department at CISSS de Laval also shared in an email on Thursday .
At a time when GP availability is at the center of the news, such demands make Dr. startle Villeneuve. “I understand the idea of standardization [les pratiques], nobody is against virtue, he assures us. But isn’t it more important to provide services to the population? »
With the collaboration of Alice Girard-Bossé, La Presse
10,546 Number of GPs in Quebec
Source: College of Physicians of Quebec
22,405 Number of doctors in Quebec
Source: College of Physicians of Quebec