wait time Archives - Your Health Matters

Spine Surgery: Why the Waits are So Long

Lisa Priest — Mon, 22 Oct 2012 14:09:00 +0000

The Question: After years of lower back pain, I have been referred to a spine surgeon. How long will it be until I undergo surgery?

The Answer: Once referred by a family physician, it can take a year to see a surgeon, according to Albert Yee, a spine surgeon here at Sunnybrook, who hears this question from patients all the time.

However, for patients whose medical problems are more urgent, they can be seen in one month. Either way, that wait represents the time to see a specialist. There is another wait – in Dr. Yee’s case about three to six months – for the actual operation.

“One of the things we ask is whether there is an operation we can perform with a reasonable likelihood of meeting their expectations,” Dr. Yee said in an interview.

Operable conditions include those to repair spines that are producing abnormal movement and require stabilization or relieve patients of nerve symptoms such as sciatica.

Waits for spine surgery can be lengthy in Canada, due to referral methods and the all-too-common presence of disabling back pain among the population.

In Dr. Yee’s practice for example, 934 patients were referred to him over a one-year period, ending in late September 2012. Of those, 458 were or will be scheduled for an assessment, 322 were redirected to a colleague after being referred and a further 154 did not have complete referral information that was requested.

“The current health care wait time environment remains challenging, particularly regarding appointments to see a specialist. It is not uncommon that a referring physician sends referrals to six or seven surgeons of the same patient so as to have them accommodated in the earliest clinic,” said Dr. Yee, Co-director of University of Toronto’s Department of Surgery Spine Program.

Patients eligible for surgery represent a fraction of those referred to spine surgeons: only two out of 10 are surgical candidates – something not unique to Dr. Yee. The remaining eight patients still require another form of treatment such as physiotherapy, specific exercises, or referral to another non-surgical spinal specialist physician.

In some ways, technology has made the matter more complicated. MRI and CT scans, used for neck and back pain, carry a 60 per cent false positive rate. Tests often reveal abnormalities that are typical in those aged 40 and older and are unrelated to the pain they are experiencing. So the very technology that is used to diagnose back related symptoms can also detect changes that don’t require a surgical intervention or any type of medical treatment.

An MRI done on a back, for example, will report an entire page of abnormalities, according to Dr. Yee, none of which may require a remedy.

“A lot of pain is related to wear and tear,” said Dr. Yee, noting that 80 per cent of people will have an episode of chronic mechanical low back pain, lasting about three or so months in their lifetime. Of those, 80 per cent will get better on their own.

“Usually, they are so happy they have the chance to be here,” said Dr. Yee, Associate Professor in the Department of Surgery at the University of Toronto. “They are also very frustrated by the future wait for surgery or frustrated they are not able to do anything. They need to realize too that their symptom constellation may change.”

So, in answer to your question, once you have seen the surgeon – which can take up to a year – it can take a few months for surgery but chances are, you may not be a surgical candidate and an operation may not be the fix for your pain related symptoms. At least you will have started to learn what treatments are available to help abate the pain.

The post Spine Surgery: Why the Waits are So Long appeared first on Your Health Matters.

Waiting for Surgery When in Hospital

Lisa Priest — Mon, 24 Sep 2012 17:43:00 +0000

The Question: My father has been on a “wait and see” list for 36 hours, with an IV drip. Once they know surgery isn’t going to happen, why wouldn’t they feed him normal food?

The Answer: The “wait and see” surgical list is ubiquitous to Canadian hospitals. That’s because a hospital, with finite resources, must operate at or near occupancy to be efficient in the public health care system. This is in stark contrast to the United States, which has the ability to treat a paying patient more quickly in a private system where hospitals, in some cases, are only half full and are looking for business.

Since your father came through emergency department, he did not have a booked operation. He was deemed clinically stable, put on an intravenous fluid to keep him hydrated, then placed in a queue for the operating room. This is probably the most frustrating part for patients. He will wait for some time – hours, sometimes several days – to move up the queue, knowing that as a trauma hospital, a more injured person coming here will be jettisoned to the top of the list. Conversely, a booked surgery may be cancelled, and your father may quickly be seen.

Still, your point is a good one: you simply want to know why he wasn’t fed and when a surgeon makes “the call” to say your father can now eat, then try the next day to get into the operating room.

“On the acute units, we depend on the call from the surgical team for further information about the planned surgery,” said Smitha Casper-DeSouza, patient care manager. “As soon as we know, we inform the patients/families.”

Patients on the “wait and see list” include those with fractures, diverticulitis, gallbladder issues or bowel obstructions.

“Sometimes a patient might be fourth on the list and might be waiting for two days,” said Ms. Casper-DeSouza. “You are on a priority list but other urgent/emergency situations may arise. The most important thing is you are medically stable and are being monitored.”

Your father is restricted from eating or drinking, to decrease the risk of vomiting during surgery so he is ready at a moment’s notice to go into the operating room.

Cynthia Holm, director of operations, OR and related services at Sunnybrook, said the physician decides how a patient will be booked. The patient could be booked into that surgeon’s elective schedule or it could be given a higher priority.

“All patients on an emergency list are further actively reviewed by the surgical team as to patient priority and patient flow,” she wrote in e-mail.

Still, it can be hectic in a hospital and they may not get back to you as soon as you would like. When that happens, ask the nurse looking after your father or the team leader for an update.

The post Waiting for Surgery When in Hospital appeared first on Your Health Matters.

A Second Opinion or an Emergency?

Lisa Priest — Mon, 17 Sep 2012 15:34:00 +0000

The Question: I am in the Emergency Department and I’m very upset. I was in another Emergency Department the day before yesterday but they just sent me home so I drove two hours to get to Sunnybrook for help. The doctor in your Emergency Department is behaving as though I’ve done something wrong. He said I should have gone back to the other ED. Don’t I have the right to go to any Emergency Department I want?

The Answer: Some patients in Sunnybrook’s emergency department are just like you: they have a medical issue they want solved, be it abdominal pain, the long wait to see a specialist or the need for a second opinion. Most physicians empathize with what prompted you to come here – in some cases, difficulty accessing timely specialty care – but that is rarely an emergency.

“Patients are doing what they are legitimately allowed to do,” said Dr. Jeffrey Tyberg, Chief of the Department of Emergency Services at Sunnybrook Health Sciences Centre. “You understand why people are doing it.”

Canada has one of the worst rates of access to specialty services. A Commonwealth Fund study of 11 countries found specialist queues particularly worrisome, with 41 per cent of patients waiting two months or more. That lack of access is partly responsible for driving up emergency visits in hospitals across the country.

“The emergency department is the only place where you can walk in and say, ‘I’m here, I’ve been to four other hospitals and I want you figure out what happened to me,’” said Dr. Tyberg.

For physicians trying to manage a limited resource of health services, it represents inefficiency to the system. If a patient has already seen a specialist and received an answer, repeating a series of tests and imaging studies will rarely yield a new insight into their medical condition.

It can be frustrating for patients, who have waited many hours in emergency, after having driven long distances – Vaughan, Barrie, Woodbridge and Peterborough – in the hope of achieving a definitive diagnosis at a top teaching hospital.

Some patients come for severe head pain, other times, they come, after having seen three other neurosurgeons for back pain for which there is no surgical remedy. Even more are stuck in long queues, waiting to see a specialist.

“They can’t work, they say it’s 14 months to see the spine surgeon in Scarborough,” said Dr. Tyberg. “What’s the guy supposed to do? You understand why people do that. It’s the only door open to a lot of people.”

To in answer to your question, you do have the right to go to any emergency department you want if you think you are experiencing a medical emergency.

To go to emergency for a second opinion or specialist consultation, while understandable due to a problem with accessing care, is not necessarily going to yield that definitive diagnosis you were seeking.

“Maybe we need to manage expectations,” said Dr. Tyberg. “People think they can come for any problem at any time. Sometimes we have to say ‘This isn’t the time or the place.’”

The post A Second Opinion or an Emergency? appeared first on Your Health Matters.