Waiting times for general health services, and surgery in particular, is commonly publicized as a growing concern for health systems which are publicly funded (Angren & Asplund, 2010). These waiting times often tend to vary depending on patient conditions as well as the supply and demand of services (Angren & Asplund, 2010). Theoretically, when the demand for a service (usually surgery) exceeds the supply, patients are usually put on a waiting list (Angren & Asplund, 2010). Waiting lists, however, have been acknowledged as a ‘complex phenomena’ that is influenced by patients, diagnostics, physicians, hospitals, governments, and societal factors (Angren & Asplund, 2010).

Health service waiting times are usually conceptualized as a linear manner, where it is assumed that patients become more distressed the longer they wait for their service (William C. Shiel Jr., 2018). Whether the wait for health services are one week or one month, any amount of waiting when one is ill can be irritating, frustrating, and a source of great uncertainty (William C. Shiel Jr., 2018). In addition, waiting times may reveal existential concerns about fear of mortality and a degree of urgency (William C. Shiel Jr., 2018).

While no standardized definition exists for waiting times regarding the period leading up to general surgery, it is generally referred, in the wait time literature, as the period between the decision to treat and the actual procedure (Angren & Asplund, 2010). However, according to Angren and Asplund (2010), patient’s perspectives of waiting times is the period from when the patient first experiences symptoms, seeks care, and finally receives treatment.

Elective surgery is a term used for a non-emergency surgery which is usually medically necessary, but can be delayed (William C. Shiel Jr., 2018). The prioritization of elective surgery is generally based on three categories that grade the urgency of the surgery, depending on the patient’s condition (William C. Shiel Jr., 2018). Urgency is defined as the clinical severity of the condition, activity limitations, and the risk of premature death (William C. Shiel Jr., 2018). Therefore, as a principal for elective surgery, patients are operated in accordance to their urgency category. However, within each category, patients are treated in the same order in which they were added to the list (William C. Shiel Jr., 2018).

When looking at the experiences of being on the waiting list for arthroplastic elective surgery, patients’ report experiencing suffering in different ways: illness, caring, and life-suffering (Angren & Asplund, 2010). This often leads to a struggle to have their basic caring needs met. Where the struggle is inevitably against a faceless enemy called “the system” as no one is there to answer or hear their desperation plea (Angren & Asplund, 2010). Furthermore, patients express several other concerns including mobility, loss of dignity, effects on family life, being alone, financial effects, and impacts on leisure activity (William C. Shiel Jr., 2018).

Groote Schuur Hospital has a wide variety of clinical areas and I was lucky enough to be placed in the Orthopaedic department for my second block of my physiotherapy clinical rotations. The orthopaedic department is subdivided into trauma orthopaedics and elective orthopaedics. Patients who had sustained any type of fracture, dislocation or traumatic injury causing bone damage are usually admitted to the trauma ward. Whereas, patients who suffer from degenerative bone conditions that require elective surgeries are admitted to the elective ward.

In both the trauma and elective orthopaedic wards at Groote Schuur Hospital, I was exposed to a broad range of conditions and gained an incredible amount of experience as I assessed and treated patients of varying ages and completely different backgrounds. Subsequently, of the several interactions on this block, one of the experiences I’ve had that stood out the most was how long patients often had to wait for their surgery. This was either because another surgery became a bigger priority or because of the lengthy waiting list that they are put on.

NPO is an abbreviation which is short for the Latin words nil per os, which means ‘nothing by mouth’ (Chon, Ma & Mun-Price, 2017). The NPO policy is standardized for majority of surgeries and states that a patient should not eat or drink for at least 24-hours prior to the scheduled surgery (Chon, Ma & Mun-Price, 2017). This is important as it prevents fluid and/or food from entering the lungs during anesthesia or sedation, thus preventing post-operative complications such as pneumonia (Chon, Ma & Mun-Price, 2017).

During my few weeks in the trauma orthopaedic ward, I’d often have to treat patients who have been NPO since the previous evening because their surgery was scheduled to be on that respective day. This affected my treatment as the patients were usually uncooperative and felt as if they did not have the energy to do their specific exercises.

Initially, this was not much of a problem as it was only one day of their treatment. However, when it became a recurring situation, where my patients were kept NPO for the entire day, only to be told later the evening that their surgery had been cancelled and that they were to be NPO the following day, it became problematic as my treatments were not being effective. NPO patients, who were referred to physiotherapy to assist with mobilization using an assistive device, could only cooperate with bed exercises and would end up not mobilizing for several days. As a result, my physiotherapy treatments were not progressing. Furthermore, NPO patients complained of feeling nauseas every day and they felt as if they were not taken seriously after finding out on consecutive days that their surgery had been cancelled because someone else became a bigger priority.

Waiting for elective orthopaedic surgery did not seem as bad because the patients could do this in the ‘comfort’ of their own home. However, these waits were usually months or even years. Although this did not affect any of my treatments, according to my patients, it greatly affected them. Patients complained of having to wait in pain and discomfort which affected their abilities to perform Activities of Daily Living (ADL’s). As a result, they became dependent on family support, which not all of them had. Others complained of becoming so accustomed to the discomfort that they felt as if the surgery was not even worth the wait. Furthermore, patients reported that during the waiting period, they were uncertain as to when their surgery would be, but that they did not feel welcome to contact the hospital to confirm their surgery date as they felt that they did not want to present themselves as a ‘nuisance’. Consequently, they felt that their life was ‘put on hold’ and that they could not plan holidays, work trips, or social gatherings without having a fear of getting an unexpected call from the hospital.

The National Standards Committee of the Orthopaedic Association states that a patient, regardless of acuity, should not wait longer than six months for surgery (Angren & Asplund, 2010). Moreover, the Western Waiting List Project suggests that the least urgent orthopaedic elective surgeries should occur within five months of the initial consultation (Angren & Asplund, 2010). Although these are the ethical waiting times before surgical interventions are done, it is evident in my experiences that this is not adhered to. Patients are kept on the waiting list for several months or even years because other’s became a bigger priority. However, if other’s are regularly bigger priorities, when are the waiting list patients a priority or are they ever a priority?

Angren and Asplund (2010), states that longer waits correlate with physical, emotional, and social decline. This can be seen in my experiences with the NPO patients who were cancelled on for several days, as it was evident that these patients were frustrated, depressed, in pain, and had decreased functional activity.

To conclude, I agree that patients who need urgent surgical interventions (because of the severity of their condition) should be treated as a priority. However, I believe that patients who are on surgical waiting lists also deserve to be heard and have a right to medical management, regardless of their position on the roster.

Reference List

Angren, N., & Asplund, N. (2010). Waiting for surgery; a continuous struggle against a faceless system. – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15921985

Chon, T., Ma, A., & Mun-Price, C. (2017). Perioperative Fasting and the Patient Experience. Cureus, 1-3. doi: 10.7759/cureus.1272. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481178/

Tracey Carr, A. (2009). Waiting for surgery from the patient perspective. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218768/

William C. Shiel Jr., F. (2018). Definition of Elective surgery. Retrieved from https://www.medicinenet.com/script/main/art.asp?articlekey=14367