Surgery points system needs review, say doctors

8.00pm

The current system of allocating points to patients on surgery waiting lists should be reviewed, the College of General Practitioners says.

An Otago University study released this week showed people on waiting lists for hip replacements and other orthopaedic surgery were reducing the ability of GPs to deal with routine general practice problems.

Otago University's Wellington Medical School research fellow Jann Fielden said results showed that it would be cheaper to carry out operations rather than keep patients on waiting lists for long periods.

College of General Practitioners president Jim Vause said today it was not just orthopaedic patients who were suffering.

"... there are things like varicose vein surgery, cardiac bypass operations for angina, gall bladder problems, skin cancer surgery, which have equally long waiting times and, in some cases, are a lot more life-threatening," Dr Vause said.

While patients suffered, GPs, physiotherapists and orthopaedic surgeons also had to provide makeshift treatments for recurring problems, wasting both their own and patients' time and effort.

"Resources do get stretched when patients must be reviewed for the point score for the waiting list. Things change over six months. Some patients get worse, some get better," he said.

Changes to the way surgery lists were made was needed.

"There is a need to improve the current point scoring system. It is better than the old waiting time system but it has had impacts that were not intended," he said.

"The (college) would welcome a programme to review and improve the current point score system for surgical procedures."

Health Ministry deputy director-general clinical services Colin Feek said earlier he did not believe Ms Fielden's study showed the current system was not cost-effective.

"The Ministry of Health recognises more work is needed to help alleviate the effects of orthopaedic surgery waiting times on general practitioners, patients, and their families," he said in a statement.

However, "significant progress" was being made in addressing waiting times for orthopaedic surgery.

A Taranaki Hospital orthopaedic trainee carried out another study that showed patients taken off surgery waiting lists suffered depression, and a loss of mobility and independence.

Study author David Ardern found that of the 111 patients he surveyed, almost 80 per cent were extremely concerned about their condition.

One patient was suicidal and six received treatment for depression; 65 were visiting their doctor more often; two had been admitted to hospital with severe internal bleeding; two had been admitted after falls; and 60 had suffered a loss of independence.

Auckland Hospital director of orthopaedic trauma Bruce Twaddle, carried out a further study on waiting times for orthopaedic patients' surgery at his hospital.

He said the trend was that the more acute the fracture, the less likely the patient was to receive surgery within time guidelines.

He said the legs of patients with broken ankles who had to wait too long for an operation could swell, meaning they had to stay in hospital waiting for the swelling to go down before they could have surgery.

They were in danger of developing a blood clot, which could need drug treatment.

Other studies had found that delaying surgery beyond the second day in hospital in such cases is associated with an increased death rate.

Mr Twaddle's findings are to be presented to an orthopaedic surgery conference today.

Mr Twaddle has been censured for speaking out over a lack of resources at the new Auckland Hospital.

- NZPA