The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskPaul@Sunnybrook.ca
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.
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