Waiting For Bariatric SurgeryWednesday, October 23, 2013
Short of flying down to Mexico and paying cash for surgery, the process of getting bariatric surgery is generally a lengthy process that involves wait times ranging from months to years (if not decades).
This clearly has significant implications for those desperately in need of bariatric surgery – in Canada at least, there is no public outcry for limited access to bariatric surgery as there is for any number of other medical procedures deemed far more “urgent” (like getting a new hip – ironically, for many obese patients, getting a new hip is not an option till they lose the weight, which they cannot without the bariatric surgery, for which there are wait times – Canada is probably the only place where you have wait times before you get to wait again in order to then wait again…).
So how is this perceived by the people waiting in line?
A paper by Deborah Gregory and colleagues from Memorial University, St John’s, Newfoundland, published in International Journal for Equity in Health, that looks a the waiting experience of twenty-one women and six men approved for surgery provides some important insights.
In-depth interviews analysed using a grounded theory approach identified three areas of inequity as a barrier to accessing bariatric surgery: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritization.
“Although excited about their acceptance as candidates for surgery, the waiting period was described as stressful, anxiety provoking, and frustrating. Anger was expressed towards the health care system for the long waiting times. Participants identified the importance of health care provider and health system supports during the waiting period.”
With regard to socioeconomic inequities, one participant declared:
“They really should have it [bariatric surgery] here because a lot of people who live here can’t afford to fly away to have it done. Yes, [provincial medical plan] will cover the surgery but they don’t cover transportation costs. Once you have the surgery, you have to stay in the area for two weeks. Are they going to pay for your hotel if you don’t have family up there? There’s so much financial burden that a lot of people – this might sound mean – but if you’re not on social services or you’re not rich, what if you’re just in that low-income bracket where you’re still considered the working poor, and you can’t get the extra help from social services or the government.”
With regard to regional and geographic inequities, another participant had this to say:
“I was always looking, I contacted Nova Scotia [another Canadian province], because I knew it was payable there, and I asked if I could get in, but it was a 7-year wait. I contacted Montreal [city in another Canadian province] to see if I could get there and it was a long wait there. I mean MCP would pay for it if I had gone to another province, but the thing is, it’s the wait, because obviously they are going to take their own patients and their own people before they take anybody else, right.”
One participant, a disabled homemaker in her 50s voiced the following.
“I know people who had the surgery that didn’t have really too many problems … Then when you see that and think, well, I’m here suffering and these people are getting the surgery done, and it’s really for people who are in need of it…. It’s hard to sit back and watch it.”
A disabled senior narrated:
“When is the day going to come? Then you find out that people are being done that weren’t even on the list, weren’t even thought of before I was…I’m 100 pounds overweight…compared to the others [pause] and looking at my medical history. I’m [states age], how long can I wait?… I want to get it done before it is too late…I hope that it is not too late.”
Based on these findings, the researchers suggest improvements to the waiting experience, including periodic updates from the surgeon’s office about position on the wait list; a counselor who specializes in helping people going through this surgery, dietitian support and further information on what to expect after surgery.
As the authors note,
“Waiting for surgery is inherent in publicly funded health care systems; however, ensuring equitable access to treatment should be a health system priority. Supports and resources are required to ensure the waiting experience is as positive as possible.”
If you have had “waiting experiences” that you would care to share, I’d be eager to hear about them.
Gregory DM, Temple Newhook J, & Twells LK (2013). Patients’ perceptions of waiting for bariatric surgery: a qualitative study. International journal for equity in health, 12 (1) PMID: 24138728