This is part of The Globe's months-long series on the challenges facing Canadian hospitals. All of our published material has been reported with permission from patients, family and staff.
Dr. Jeffrey Gollish is the Medical Director of the Holland Orthopaedic & Arthritic Centre and the head of the lower extremity arthroplasty program for Sunnybrook Health Sciences Centre. He has been an orthopedic surgeon for 28 years and is recognized for his work on the development of minimally invasive surgical techniques in hip and knee arthroplasty.
What’s the best thing about being a knee and hip surgeon?
The most gratifying thing about my job is returning people back to an active life. I wish I could say it was everybody. But I think the most gratifying thing is the many, many people whom I’ve helped over my career to be able to get back to their life… play with their kids and grandchildren and so on. It’s really rewarding to know that I have helped so many people.
What's the biggest challenge you face in a regular day?
As a surgeon, I think one of my biggest challenges is trying to sort out how to make more people happier with the outcome of their surgery. We’ve done a lot of work on surgical technique. There have been a lot of developments in terms of new joint replacement and so on. [However], we haven’t really seen a significant increase in satisfaction rate after joint replacement. There’s been a lot of work done on it. They’re trying to sort out the reason for dissatisfaction, whether there’s actually a mechanical problem with the joint that may be fixable or not, or whether patient expectation is out of keeping with what we can deliver.
On the administrative side, part of it is just the huge demand for service and the inability to currently get the wait list down to where we’d like them to be.
How have wait times for knee and hip surgery changed over the years?
Ten years ago, before we really started to change the system, wait times were very long and we traditionally have focused on what now is called Wait Two, which is the wait time from consultation to surgery. And that would vary from anywhere from six months to two years for surgeons across the province and across the country.
The other was, of course, Wait One, which is the wait time from referral to consultation. And again, that could vary from three months to two years. So, if we looked at the total wait time from referral to surgery, patients were waiting probably a minimum of a year, and then three to four years or more before they actually ended up in the operating room.
As part of the metrics of health-care delivery across the country, one of the 10 things the federal government looks at [is] wait time for joint replacements as one of the indications of the health of the health care system. With the emphasis on reduction on wait time, we [saw] an improvement in reduction in wait time. That occurred, quite honestly, as a result of an influx of money to allow for more operating time for joint replacement. And some changes in the models of care delivery to reduce Wait One so for patients to get seen by someone to have their status assessed and get triaged appropriately into the lineup.The focus on Wait Two is where the money went, in a sense, was to try to improve the resources available for joint replacement and we saw a significant reduction in joint replacement wait times across the country on average, but unfortunately we’re seeing those wait times creep back up again as the resources that we have now, which was expanded, is now no longer capable of managing the demand for service because of the baby boomer blip that’s coming through.
How has pre-surgery assessment changed things?
The model that we have now at Sunnybrook is that the referrals all go through a central intake process. That helps us a lot to understand the demand for service because we know on an annual basis how many people are being referred in for service. All of those referrals get triaged initially for the information that’s provided so we can then move them to the next level of triage. And then through the assessment centre’s process, because we’re not waiting for the orthopedic surgeon’s time, we’re able to offer people an assessment within two to three weeks of their referral.
For the patients, that really means once they’ve been identified that they need someone’s opinion with respect to the severity of their arthritis and their options for management, they're not waiting three to six or whatever months down the road.
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Once the advanced practice physiotherapists see the patients in the assessments centre, they are able to triage them in according to severity so that people who are very bad don’t wait forever.
Ten years ago, it would be very common for someone on a regular basis to come into the clinic in a wheelchair having waited, and waited, and waited for a referral , waited for a consultation, they’ve been sitting in a wheelchair for months, their functional level has deteriorated, they’re unfit, they’ve put on weight – we just never see that any more.
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