[The problem of waiting lines for otorhinolaryngology surgeries in public services].

According to Article 196 of the Brazilian Constitution “Health is a right of all citizens and a duty of the State”. The constitution is supplemented by the organic Act 8080, dated from 1990, which sets the guidelines for the Brazilian universal health service, SUS (in Portuguese Sistema Único de Saúde), ensuring universal access to health services. In spite of the legislation’s theoretical excellence, it is common knowledge that access to public services is one of the most serious problems in our society. The factors leading to this scenario are, unquestionably, absence of an efficient and hierarchical structure, scarce financial resources for health and not enough investments in hospitals, health professionals and technology. Waiting lines are lists of patients requiring the same treatment or medical services whose demand is larger than the supply. Metaphorically speaking, patients in this line are kept in a virtual room, waiting for the same procedure, and are called on a one-by-one basis, according to order of arrival. The waiting line for elective surgery is a reality in many general hospitals throughout Brazil, which can be longer or shorter in terms of number of patients and time in wait. Although an integral part of the daily routine of surgeons working in public service facilities, the waiting line issue is not frequently tackled by the medical-scientific community, owing perhaps to the fact that this seems to be a discussion that does not belong in the academic sphere and that should be circumscribed to governmental instances. However, it must be highlighted that equitable, fair and universal access to health services must be a constant concern not only of governments but also of all professionals involved with the public service network. There is a lot that can be done locally to mitigate waiting lines. This article tries to discuss this issue from our specialty’s perspective, bringing up some points that we consider to be of great relevance. Waiting lines for surgery: The tip of the iceberg Before being submitted to otorhinolaryngologic surgeries in the public network, patients must actually sit on several consecutive waiting lists. The waiting time for surgery —representing the time between surgical indication and its actual performance— is but the last, and many times the shortest, of these waiting lines. Total real wait-time covers many other previous time-spans, starting at symptom onset and ending when specialized treatment is finally delivered. Each one of the steps is characterized by its own difficulties and delays (Figure 1). The phases prior to treatment at the otorhinolaryngology service are much more difficult to size, but are not less important. All different phases are worthy of special and knowledgeable attention so that obstacles may be identified, feasible solutions may be found and the flow of patients may be optimized. First of all, one can see that there is a time lag between the onset of the disease and the action of seeking medical help (arrow 1 in Figure 1). This is partly due to lack of information on otorhinolaryngologic diseases and the most important presentations requiring medical attention. Information campaigns on Voice and Hearing, such as the ones supported by the Brazilian Society of Otorhinolaryngology are instrumental for changing this scenario. Next we have the difficulty in obtaining medical services (arrow 2), a consequence of the problems in our health policy, its faulty structure and the lack of resources for health care in Brazil.