Waiting For Bariatric Surgery
Wednesday, 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.
@DrSharma
Edmonton, AB
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
Wednesday, October 23, 2013
My wait really wasn’t too bad – I’m in the Vancouver area and had my surgery July 18, 2013 after being referred Feb 2012. It was a little frustrating seeing Americans getting their surgery in a few weeks or months, but I used my weight as an adjustment time. I knew surgery would demand new habits, and that the program here was strict about them, so I started eating more like a post surgical patient, increased my activity, and dealt with some of the emotional causes of my weight. We also have a patient-run support group on Facebook & in person that is a huge help. The worst part was when there was a possibility of losing funding, so we rallied and sent letters to the Health Minister, and the funding was increased!
(The wait for a consult with my surgeon is now closer to 2 years, but it’s better than the clinic in Victoria where you have your initial consult quickly, but then wait 5 years or more)
More funding definitely needs to be put toward Bariatric surgery (and related professional activities). The cost savings alone should justify it – the surgery (plus plastic surgery to remove excess skin) must cost less in the long run than treatment for diabetes, hypertension, etc. there are so many in our program that no longer require treatment for a host of conditions, often within a few weeks or months of surgery.
Wednesday, October 23, 2013
Every American should read this and think deeply about how this type of system would work in America, because make no mistake, the ACA is just a stepping stone to single payer. There are inequities in every system, do I really want my government to choose the inequalities for me? There is not a doubt in my mind that I would have done my research, picked the best doctor and traveled to see them in any part of the world. I would have paid cash if necessary. However, most people do not have the resources to do this and are stuck dealing with government bureaucracy– welcome to socialized medicine. This reminds me of my childhood in the former Soviet Union, everyone had enough–enough to live miserably, but at least it was “fair”.
Wednesday, October 23, 2013
Hi Arya: The cartoon at the top of your blog is quite humorous as the people depicted all have a BMI under 25 (est. ) On a more serious tone our program has worked well to help people lose weight to either help them to reach their surgeons stated goal or to the point where the patient is so improved that they have reconsidered surgery. Although surgery is a proven effective way to lose weight, it is not the only way and many can be helped by multidisciplinary, meal replacement programs under physician supervision. Best regards.
Wednesday, October 23, 2013
I find access to bariatric anything (at least in Alberta) laughable.
I asked my doctor for a bariatric referral and he gave me one. It was 2 years before I received a letter from the program inviting me into a lap band lottery whereby I would follow a diet and exercise program and based on my performance I could then be chosen (seemingly at random) as 1 out of 25 surgeries in Calgary that year.
In the mean time, I had researched and chosen my surgeon, applied, went through the battery of tests, had my RNY surgery and lost 125 pounds.
I paid over $20000. (worth every penny) When I submitted my receipts to the government for reimbursement, they returned $1200 to me. Considering at the time of my surgery, I was losing my mobility due to obesity, I have saved the system many times what I would have cost them.
Since bariatric surgery is the only proven method to maintain a significant weight reduction for the morbidly obese, it seems crazy how the access is so limited. It took 2 years to even know if the program had even received the referral. Obesity is progressive. Waiting only makes it worse.
Thursday, October 24, 2013
As a matter of fact, part of my decision to head south was a post from you that had a link to one of Dr Alvarez’s patient’s stories and the comment,”You can’t argue with success.” There was a further comment from Dr Karmali saying that the story was inspiring. Suddenly all of my reading about traveling to Mexico didn’t seem crazy after all. My husband and I talked to our GP the following morning, got his support and encouragement, and I booked my surgery the next day – for 3 weeks later. (I’d been reading about the various surgeons for a couple of years – I didn’t just jump without doing my research) It kicked a big hole in our savings, and I felt guilty about that, but I’ve never for a minute regretted going. I do believe that the surgery should be available locally, in a timely manner (3-6 months) and either fully funded or with a reasonable co-pay, but until that happens I’ll continue encouraging people that want to go the route I did. While I’m still obese, losing the 80# I have since surgery has transformed my life, and no amount of fat acceptance can take the place of not having to haul that fat around.
Thursday, October 24, 2013
Great post. I am the director of the Wharton Medical Clinic (a community based government supported no charge lifestyle clinic in Ontario), and we support patients as they wait for bariatric surgery. Approximately 7% of our 40,000 patients have been referred for bariatric surgery (almost 3,000 patients). There is a 2 year waitlist in Ontario. During that waiting time, we see patients as often as they need (average every 3 – 6 weeks), with support from a counselor, exercise specialist, nutritionist, dietitians and the MD. It is clear that patients need a lot of support during this waiting time and we are obliged to provide it, as the waiting list grows longer.
I am hopeful that other provinces develop community based programs that can help support bariatric patients during this time period, it does not have to be stressful, clearly there is a better way.
Thursday, October 24, 2013
Dr. Sharma, can you explain to me why there is a weight loss requirement before joint replacement surgery is done? It seems it can’t be because the new joint can’t tolerate a heavy weight, since most people who lose weight quickly regain it, thus putting as much pressure on the joint as the original weight did. Is it because excess weight makes mechanical insertion of the joint difficult? Are there anesthesia concerns that weight loss will alleviate? Is it just because doctors have a bias against fat people and want to make them “pay” before they can get a painful joint replaced? Or none of the above?
Your explaining this would be a great help. Thank you!
Thursday, October 24, 2013
Sorry – there really is no explanation except for the weight-bias amongst orthopedic surgeons. There is certainly no evidence that obese people have more complications or poorer outcomes.
Thursday, October 24, 2013
I absolutely agree, Kirsten. I weighed 304# when I got myself referred to the Edmonton program, spent a year doing modules and losing 20#, lost another 25# while attending many months of appointments at the clinic, then was denied surgery “because I was unlikely to lose more than another 10-15#, and we don’t take the risks of surgery for only 10-15#” I weighed 258# at the time. I was devastated.
I spent the next 6 months desperately working at keeping that 45# off on my own. then regained 12# after an injury. When I couldn’t get that 12# back off I got my doctor to refer me to the clinic again. I discovered a month later that it would take another 3 months until my first clinic appointment – and they were starting me over from the beginning – with no promises of the surgery my family doctor had agreed I needed. I was done.
By the time my intake appointment was due I’d been to Mexicali, had my VSG surgery and had lost 34#. I’m now fairly easily maintaining 185# and our family doctor says it’s time to talk about plastic surgery to remove the hanging skin on my belly, arms and inner thighs. I’ll be paying for that, too, since he says the wait time will be 2-3 years if I go through the public system.
I’m one of the lucky ones. We had some savings, my family doctor has been wonderfully supportive and my family has been wonderful. (And my sister, husband and daughter have been sleeved in Mexicali since) If we hadn’t had the money to pay our own way I’d be back to the misery that was my life at 304# – or more.
Bariatric surgery is about losing the weight, yes, but even more importantly it’s about having a fighting chance of KEEPING the weight off.
Saturday, October 26, 2013
My first appointment at the Edmonton clinic was late Feb. 2013 after waiting for a few months, and i was put on the waiting list of one the surgeons on July, the problem is that I moved to calgary and my follow ups now are every one and a half to two months, I have to take a day off my new job, travel to Edmonton. I do feel abandoned and unsupported. I called the surgeon’s office to find about an estimation of my waiting time, this was about 3 weeks ago and no reply yet, i wish what the study suggests can be really applicable.
Sunday, October 27, 2013
Have watched my husband with knee problems accumulate weight over the years, very slowly but increasingly debilitating. Dr referred for WLS in Nova Scotia back in 2010. Dr re-referred to WLS three times in these 3 years. Have not even had a whisper of any help. Co-morbilities – CPAP, insulin dependent diabetes, GERD, back pain and other private health issues.
Worse part of this wait time (on top of the increasing health issues) is that he feels very unimportant to anyone. No phone call, no email, no letter for over three years.
NOVA SCOTIA shame on you.