Joseph
April 23rd, 2009, 18:17
http://www.thestarphoenix.com/Health/Region+restricts+circumcisions/1524711/story.html#Comments
Region restricts circumcisions
Procedure no longer performed at RUH
By Lana Haight, The StarPhoenix April 23, 2009
The Saskatoon Health Region is moving to further restrict infant circumcisions, despite new research that shows benefits of the procedure.
"This is not patient-centred care," said Dr. Steven Goluboff, a family physician in Saskatoon.
As of April 1, infant circumcisions are no longer performed at Royal University Hospital even though that's where all babies in Saskatoon are born. Parents wanting their baby boy to be circumcised must make arrangements with a family doctor to perform the procedure either in the doctor's office or at the outpatient departments at St. Paul's or Saskatoon City hospitals.
A lack of nursing staff is one of the reasons for the change, says Dr. David Poulin, vice-president of medical affairs for the Saskatoon Health Region.
"You need the nurse right there, providing full attention to the procedure, and if you're booking several procedures in a row you have to have nurses there for a certain amount of time," he said.
"It just became an extra thing to try to staff for and particularly if you are already having some staffing challenges on the unit, it became much harder to manage."
A report prepared by senior administrators in December 2008 recommended infant circumcisions not be allowed in any of the city's hospitals, citing limited human and fiscal resources.
"Appropriateness is also an issue," said the report.
"It is not appropriate to provide access to an unnecessary procedure in acute care."
After several family doctors took issue with the decision to stop allowing newborn circumcisions in all of the hospitals, the health region administration agreed to allow them at St. Paul's and City.
Goluboff disputes the reasons given by the administrators.
"I think they made a big mistake. I think they picked the wrong minor procedure to single out," he said.
"I mean it takes me five minutes (to perform a circumcision)."
He also takes issue with the report identifying circumcision as "unnecessary."
"We shouldn't be suggesting that it's a bad thing to do to little boys," said Goluboff.
"I believe that this policy was based on a philosophy that circumcisions are bad and shouldn't be done."
The Canadian and American pediatric societies direct physicians to discuss with parents the pros and cons of having their newborn boys circumcised. The Canadian society is currently reviewing its policy in light of new research.
In 2006-07, 526 babies were circumcised in Saskatoon hospitals. About the same number were circumcised in doctors' officers, with almost 350 circumcisions performed in one Saskatoon clinic alone, according to statistics provided by the health region.
Poulin says many doctors prefer to perform the procedure in their clinics because it's more convenient for them. And he says babies and their mothers are discharged so soon after babies are born that it's too early to circumcise them before they leave the hospital.
Poulin makes no promises that infant circumcisions will continue to be performed in outpatient departments. All ambulatory care services in the Saskatoon Health Region are under review and it's possible access to newborn circumcisions could still be eliminated at health region facilities.
"In the meantime, we said we hear what the family physicians are saying. They're just not ready, many of them, to be able to do this in their offices and they're not equipped. We won't discontinue this practice in the hospital fully and we'll maintain it in the outpatient areas," said Poulin.
Because infant circumcision is not paid for by the provincial government, the health region charges parents $90 to have a baby circumcised. The parents also pay the doctor to perform the procedure.
Goluboff worries parents aren't being provided with enough information for them to make an informed choice. And, he says, the information they are receiving at pre-natal classes offered by the health region is often slanted.
"Their rhetoric, from what I hear from my patients, is really negative. It's an unbalanced view," said Goluboff.
That leaves parents at a loss when the time comes for the baby to be circumcised, he says.
Poulin recommends that parents discuss the benefits and risks of circumcision before their baby is born so arrangements can be made with a doctor to perform the procedure within days of the baby being discharged from hospital.
lhaight@sp.canwest.com
Region restricts circumcisions
Procedure no longer performed at RUH
By Lana Haight, The StarPhoenix April 23, 2009
The Saskatoon Health Region is moving to further restrict infant circumcisions, despite new research that shows benefits of the procedure.
"This is not patient-centred care," said Dr. Steven Goluboff, a family physician in Saskatoon.
As of April 1, infant circumcisions are no longer performed at Royal University Hospital even though that's where all babies in Saskatoon are born. Parents wanting their baby boy to be circumcised must make arrangements with a family doctor to perform the procedure either in the doctor's office or at the outpatient departments at St. Paul's or Saskatoon City hospitals.
A lack of nursing staff is one of the reasons for the change, says Dr. David Poulin, vice-president of medical affairs for the Saskatoon Health Region.
"You need the nurse right there, providing full attention to the procedure, and if you're booking several procedures in a row you have to have nurses there for a certain amount of time," he said.
"It just became an extra thing to try to staff for and particularly if you are already having some staffing challenges on the unit, it became much harder to manage."
A report prepared by senior administrators in December 2008 recommended infant circumcisions not be allowed in any of the city's hospitals, citing limited human and fiscal resources.
"Appropriateness is also an issue," said the report.
"It is not appropriate to provide access to an unnecessary procedure in acute care."
After several family doctors took issue with the decision to stop allowing newborn circumcisions in all of the hospitals, the health region administration agreed to allow them at St. Paul's and City.
Goluboff disputes the reasons given by the administrators.
"I think they made a big mistake. I think they picked the wrong minor procedure to single out," he said.
"I mean it takes me five minutes (to perform a circumcision)."
He also takes issue with the report identifying circumcision as "unnecessary."
"We shouldn't be suggesting that it's a bad thing to do to little boys," said Goluboff.
"I believe that this policy was based on a philosophy that circumcisions are bad and shouldn't be done."
The Canadian and American pediatric societies direct physicians to discuss with parents the pros and cons of having their newborn boys circumcised. The Canadian society is currently reviewing its policy in light of new research.
In 2006-07, 526 babies were circumcised in Saskatoon hospitals. About the same number were circumcised in doctors' officers, with almost 350 circumcisions performed in one Saskatoon clinic alone, according to statistics provided by the health region.
Poulin says many doctors prefer to perform the procedure in their clinics because it's more convenient for them. And he says babies and their mothers are discharged so soon after babies are born that it's too early to circumcise them before they leave the hospital.
Poulin makes no promises that infant circumcisions will continue to be performed in outpatient departments. All ambulatory care services in the Saskatoon Health Region are under review and it's possible access to newborn circumcisions could still be eliminated at health region facilities.
"In the meantime, we said we hear what the family physicians are saying. They're just not ready, many of them, to be able to do this in their offices and they're not equipped. We won't discontinue this practice in the hospital fully and we'll maintain it in the outpatient areas," said Poulin.
Because infant circumcision is not paid for by the provincial government, the health region charges parents $90 to have a baby circumcised. The parents also pay the doctor to perform the procedure.
Goluboff worries parents aren't being provided with enough information for them to make an informed choice. And, he says, the information they are receiving at pre-natal classes offered by the health region is often slanted.
"Their rhetoric, from what I hear from my patients, is really negative. It's an unbalanced view," said Goluboff.
That leaves parents at a loss when the time comes for the baby to be circumcised, he says.
Poulin recommends that parents discuss the benefits and risks of circumcision before their baby is born so arrangements can be made with a doctor to perform the procedure within days of the baby being discharged from hospital.
lhaight@sp.canwest.com