Delays for knee surgery: wait until you lose your dignity

A 64-year-old man's 30-month wait for knee surgery completely undermined his quality of life, so he had to stop working, playing hockey, and couldn't even make it anymore to shovel his driveway.

Delays for knee surgery: wait until you lose your dignity

A 64-year-old man's 30-month wait for knee surgery completely undermined his quality of life, so he had to stop working, playing hockey, and couldn't even make it anymore to shovel his driveway.

• Read also: The wait for elective surgery varies depending on... your postal code

“I felt diminished like no one else,” admits Daniel Audet, 64 years old. The Île-Perrot resident finally went under the knife last March, after a two and a half year wait.

He was operated on at the Hôpital du Suroît, in Salaberry-de-Valleyfield, the establishment in Quebec with the longest delays. In September 2019, he was warned that there would be a year of waiting, he says. After two years, he was 7th on the waiting list... and the surgery finally took place six months later.

“Having known that we could choose to have the operation elsewhere, I would have done it […] It was really unbearable in the end”, breathes Mr. Audet.

Even though he had established a bond of trust with his surgeon, the long months of waiting had a very heavy impact on his quality of life.

"If I hadn't had that brace, I would never have been able to tolerate [the wait]," he says, pointing to the device he had to wear around his knee all the time.

After a year of waiting, he couldn't live without it. Without the brace, he was unable to mow his lawn, for example.

It was also at this time that he had to completely stop playing hockey, a sport he practiced frequently. Mr. Audet also became more fearful when he took steps, aware that he might not be able to return home if he went too far.

But the worst happened after two years of waiting. Service manager in a Metro grocery store, the sexagenarian was struggling to finish his working days.

“LIKE A LITTLE OLD”

“I saw myself as a little old man who is struggling and who is not able to do his job”, he confides, feeling his dignity affected.

“I have always been proud at work,” he continues. But for the first time in his life, he was looking forward to taking an afternoon break just to rest his leg.

His doctor put him on compulsory leave, to the relief of his boss and those close to him. But those six months before surgery also mean a loss of income.

Today, the recovery is difficult, says Mr. Audet, adding that it would undoubtedly have been easier if he had been younger and without the weight gained due to his sedentary lifestyle for the past few months.

The case of Mr. Audet is far from unique. Orthopedics has been hit hard by the pandemic, as these “non-emergency” surgeries are often the first to be postponed.

20 TIMES MORE WAITING

Since February 2020, the number of patients waiting for an operation for more than a year has increased from 300 to 6,400, or 20 times more.

And the demand for knee braces will continue to increase until 2035 due to the aging of the population, predicts the Association des orthopédistes du Québec.

"Waiting lists are exploding because there is no anticipation and care for this clientele in the medium and long term", deplores the president, Dr. Jean-François Joncas.

– With the collaboration of Héloïse Archambault

The worst delays in Quebec for cataract surgery are in Châteauguay, where the brand new operating room has been closed for almost two years.

"It's nonsense, we have a brand new ophthalmology department, which has hardly ever been used," pleads optometrist Darkise Richard, who comes up against a wall.

According to the latest data from the Ministry of Health and Social Services, the average waiting time is 40 weeks at Anna-Laberge Hospital in Châteauguay, the worst in Quebec. A wait four times longer than in Longueuil, Saint-Jean-sur-Richelieu or Lachine, for example.

Why so many disparities? “You put your finger on the bobo,” replies the president of the Association of Ophthalmologists of Quebec, Dr. Samir Lahoud. He regrets that the agreements with specialized medical centers (CMS) do not take into account waiting lists.

For its part, the CISSS de la Montérégie-Ouest is short of explanations. If the expectation is so great in Châteauguay, it is because the block was closed during the pandemic and the beaches in CMS are not enough, answers councilor Jade St-Jean.

The CISSS gives itself 12 months to reach an “acceptable level”. However, the new outpatient ophthalmology clinic in Châteauguay, inaugurated in 2018, was supposed to allow 1,000 additional cataract surgeries to be performed.

REFUSED PATIENTS

Optometrist Darkise Richard also comes up against a point of inadmissibility if she tries to direct her patients to where the wait is less.

“I am told that I am out of territory. They don't want my patients,” she says. However, the law allows a patient to go where he wants.

ALREADY LOSS OF AUTONOMY

“No one is going to die of cataracts, but it is elderly people who are losing their autonomy. They can no longer drive and they lose their activities, their friends. It creates isolation,” she laments.

Recently, her own father needed cataract surgery. But from the outset, she is told that it will have to wait until 2023, she says.

“I change his glasses every three months, otherwise he no longer sees clearly. But you can't change glasses indefinitely,” she says.

Otherwise, more and more patients are deciding to pay up to $4,000 per eye to be operated privately in a few days.

The government is heading down a slippery slope by relying on private clinics to reduce the huge waiting list since the pandemic, doctors fear.

“To think that the private sector will save us is to refuse to see the exodus of personnel it causes,” says general practitioner Joanie Tremblay-Pouliot, of Quebec Doctors for the Public Regime (MQRP).

“What explains the wait is a lack of human resources to run the operating rooms, not a lack of equipment. The bottleneck is because it is understaffed. No surgeons, but a lot of nurses and technicians,” she continues.

NO MORE NURSES

The doctor sees it as a “chicken and egg” phenomenon. The more nurses go private, the fewer there are available in the hundreds of hospital operating rooms. And the more the private sector is solicited, the more it recruits.

"We always work with the same nurses, they don't duplicate each other," she argues.

For its part, the Federation of Medical Specialists of Quebec does not believe that the future of the network depends on the development of specialized medical centers (CMS).

“As long as we do not return to the pre-pandemic waiting lists, they will be useful, thinks Dr. Serge Legault, vice-president of the FMSQ. If we were able to repatriate CMS customers to hospitals, it would be much simpler.”

15% PROFIT

For the researcher specializing in health at the CHU de Québec, Maude Laberge, the important thing is to avoid an explosion of expenses.

"If private clinics can provide an equivalent service at a lower cost [...] I don't see why we wouldn't do this collaboration with the private sector," she said.

However, the profit margin of CMS increased from 10 to 15% last year according to what Le Devoir reported.


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