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Question: My right knee is worn out and I am waiting for an operation to have it replaced by a highly-respected Toronto surgeon. I’ve been waiting months and my pain is getting worse. A friend told me I might be able to get an operation sooner if I got put on the doctor’s cancellation list. How does that work?
Answer: It’s true some surgeons have cancellation lists. If a patient doesn’t proceed with a scheduled surgery – for whatever reason – someone on the cancellation list will get offered the spot.
The cancellation list seems like a good solution, but it’s not as easy as it sounds, cautions Dr. Jeffrey Gollish, medical director of the Holland Orthopaedic & Arthritic Centre of Sunnybrook Health Sciences Centre.
For starters, you are not going to get much advance notice. You might receive a phone call from the doctor’s office only a week to 10 days before the surgery and very few people can drop everything else so quickly in order to move forward with the surgery.
“When my secretary calls them up, they will often say they already have a commitment that week,” explains Dr. Gollish. “It is a very small percentage of people who will actually do it. ”
And it’s not just the day of surgery that you need to consider. It will take many weeks to recover from the operation. During that time, you won’t be very mobile, you will be on heavy-duty pain medications and you will need to devote yourself to physiotherapy.
So don’t book a major overseas vacation if you are hoping to take advantage of a possible cancellation. If you have a job, you may want to let your employer know that you may need to take time off work without much advance warning.
“It’s a huge challenge for people, and that’s why the cancellation list is a limited option,” says Dr. Gollish. “People really aren’t as available as they think they are.”
However, there are other ways you may be able to shorten how long you have to wait for knee surgery.
You mentioned that you are currently booked to have your operation with a “highly-respected” Toronto surgeon. You can safely assume that a high-profile doctor is going to have a longer than average wait list. If you are willing to have the surgery performed by someone else, then you might be able to get a new knee in less time.
For instance, your surgeon may be able to recommend someone else with a shorter wait list. Or, you could go through a centralized referral service run by the Local Health Integrated Network, or LHIN.
Back in 2006, the Ontario Government set up a total of 14 LHINs across the province. Each one of these non-profit corporations works with health-care providers and community members to determine local health-service priorities.
And, where you live, the Toronto Central LHIN has created a method of coordinating surgical services for certain high-demand procedures, such as total knee and hip replacements.
Your family physician can make a referral for you through a single fax number (1-877-411-4577) and may request: the first available appointment with an orthopaedic surgeon within the Toronto Central LHIN; the first available appointment with an orthopaedic surgeon at a specific Hospital; or an appointment with a specific orthopaedic surgeon.
At some of the hospitals – including Sunnybrook’s Holland Centre, Mount Sinai Hospital and St. Michael’s Hospital – the patient is seen first by a specially-trained Advance Practice Physiotherapist, who performs a comprehensive assessment and provides education about the condition. If the physiotherapist and patient conclude a joint replacement is needed, an expedited appointment would then be arranged with an orthopaedic surgeon.
(In other parts of Ontario, some – but not all – of the LHINs run similar referral services. “Others have used different approaches to wait times or aren’t facing the same challenges, “ says Megan Primeau, a spokesperson for the Toronto Central LHIN.)
You also have one more option that may speed up your surgery date – and it depends on the condition of your knee. You noted in your question that your pain is getting worse. If your knee has seriously deteriorated from when you first saw your surgeon, he (or she) could move you up on his (or her) own wait list.
You would need to book an appointment for a re-assessment. “The surgeon will have to examine you and feel it’s justified to move you ahead of others… based on an objective assessment of the severity of your arthritis and functional impairment,” says Dr. Gollish.
Keep in mind that pain alone wouldn’t be a reason for changing your position in the queue.
“Most people are in the same basket,” he says. “They have got pain. They have limited range of motion. They can’t do the things they would like to do. And they would like to have the surgery.”
Provided you can be flexible and organize your life around the demands of the surgery, you might be able to take advantage of one of the short cuts to the operating room. But if none of these options work, you should still talk to your family doctor about what can be done for your pain. Even the use of non-prescription medications can bring some relief as you wait for your surgery.
Patient Resources:
There are many educational materials available to help patients prepare for surgery. Preoperative guides and a video, along with other resources such as exercise and activity guidelines, can be found on the Sunnybrook website. (http://sunnybrook.ca/content/?page=Focus_MSK_Info)
Additional resources available to patients include:
- Canadian Orthopaedic Foundation: www.canorth.org
- Community Care Access Centres: www.ccac-ont.ca
- Joint Replacement Surgery: www.myjointreplacement.ca
- The Arthritis Society: www.arthritis.ca or 416-979-7228
- Physiotherapy: www.opa.on.ca or 416-322-6866
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. His blog Personal Health Navigator is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Email your questions to AskPaul@sunnybrook.ca and follow Paul on Twitter @epaultaylor
The comments section is closed.
I am on the waiting list for a hip replacement. I have lost some weight and doing exercises. Am still doing pretty good and told the booking agent that I am not in a hurry to have the surgery, but would prefer to wait. I was told recently, that if I refuse to take the next date they give me, I will get dropped from the list and have to start all over again. I can not risk going off the list, because sometimes things can get worse quickly and the waiting list then would be well over a year. I had asked my surgeon at the time, that if I am still in OK shape when the time comes, if I can wait and remain on the list. He assured me that that is not a problem and if my situation changes, I can call and will have a shorter waiting time. I do not understand why the system is pushing me to do the surgery before necessary, when there are so many people waiting, that are in serious pain. What should I do ?
What to do when surgery was cancelled and now you are on a wait list again after just waiting for over a year?
I share Dr Gollish’s sentiments completey.
But, the reader is bringing up an extremely important point, that is echoed in Dr Gollishes comments.
How bad is the problem? The pain may be increasing but generally, that if the joint condition is not changing (based for instance on X-ray changes) than justification for an earlier date may not be there. On the other hand, the current evaluation, even within a MSK clinic, is not based on hard evidence. There is a need for objective evidence based information on the extent of disability and, more importantly, the severity of the joint damage.
This kind of evaluation/re-evaluation is feasible and does not need another clinic appointment.
But does the patient have to see the new surgeon prior to the surgery or does the patient meet her surgeon in the operating room for the first time?
Hi Gerald:
The patient will have an appointment with the surgeon well before the actual operation.
So there is very unlikely to be a saving of time for the patient himself as the waiting time for the visit to the new surgeon’s pre-op visit will almost certainly negate the time on the surgical waiting list.
The fact that the patient will have had consultations with two surgeons will also clog the health care system further and cost the health care system more money.
All things considered, I think it‘s fair to say that a patient’s best bet (for the soonest operation) would be to go through the LHIN’s centralized referral process and request the first available appointment with an orthopaedic surgeon within the LHIN.
Once you are on one surgeon’s waiting list, do you have to wait for an appointment to see the second surgeon prior to getting on the second surgeon’s OR waiting list?
Hi Gerald:
If you are currently on one surgeon’s wait list, you can still ask your family physician to refer you to the LHIN’s centralized process for the first available surgeon.
Actually, my wife recently had knee replacement surgery. She was on the wait list of a particular surgeon and decided to switch to the central referral service run by the LHIN. But, just by chance, she got a call from her surgeon, offering a cancellation spot. So she ended up having the operation performed by her original surgeon after all.
Paul Taylor