Time-sensitive Elective Surgery

By 2020-05-30Focus

Did you know? – During COVID-19 lockdowns, many doctors and patients have struggled to get authorization from their insurers for medical and surgical procedures because these were deemed “elective”. However, elective simply means that the doctor and patient can “elect” the day, time and place to perform a procedure optimally. That is, in a familiar environment, with familiar staff and instruments, a rested surgeon and a stable, nil per os patient. Elective does not mean that there are no time-sensitive aspects to a procedure. In fact, elective procedures are essential, because they minimize urgent procedures, which in turn minimize emergency procedures.

Take cataract surgery for example. Very elective. We might as well do it 5 years’ time rather than now, under lockdown. Right? Not exactly. First, cataract surgery has been shown to reduce the risk of all-cause mortality; the vulnerable become less vulnerable. Sure, most cases can be delayed to some extent without harm. However, there are many intrinsic time sensitive elements to cataract surgery. The older a patient gets, the harder a cataract becomes, and at some point it can become hard enough to make surgery more difficult. Some cataracts contribute to narrowing of a delicate angle inside the front of the eye and this can cause acute glaucoma. Cataracts can obscure the view of the back of the eye and interfere with the evaluation and treatment of other pathology like nerve thinning and retinal bleeding. Workers delivering essential services now face increased demands in some sectors and risk accidents as their cataracts become more symptomatic. The list goes on.

Remember that the decision to treat or not lies with the patient, a qualified and trusted doctor, and the respectful discussion between them, not with your medical aid or their medical advisers.

One Comment

  • Denver says:

    Well said Johann. There is very little justification for the majority of elective surgeries to be delayed or dejected.
    Whilst the WHO called for cancelling of elective surgery it was well assumed by patients that Covid cases became priority. Such a blanket directive only results in patients weakening to the extent that they end up being walking time-bombs. Since we are now in level 3, it is vital to lobby for appropriate surgical care to patients, taking into account risk stratification with a high level of awareness that the peak is yet to come.

    Rationing of healthcare resources in terms of limiting patients acces to surgery now has to be weighed up against the background of both health and economic disaster as a consequence.

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