Prohibitions on elective surgeries, in place in most states since early March, have taken a toll on hospitals, physicians, and other healthcare workers. But patients may be the group that have suffered the most.
“A lot of treatment has been delayed that was important but not necessarily emergent,” said Dr. Juliette Madrigal Dersch, a primary care physician in Marble Falls, Texas. Elective surgery includes heart operations, cancer treatment, joint replacements, and spine surgery. “Elective” only means that it is not a medical emergency, not that it is unnecessary.
Ann Herlocher’s daughter, Abby, needed ear tubes due to recurrent ear infections. But the procedure had to be canceled back in March. “Abby started having ear infections beginning of the year and has four back to back ear infections since January. It was double ear infections too, so, poor kid,” Herlocher told an NBC affiliate in Houston.
Pain is a common theme when speaking to physicians about the toll on their patients.
“One patient of mine has a ruptured disk and a pinched nerve, but she’s not an emergency case, so she’s had to wait over three months for surgery,” said Dr. John Dietz, an orthopedic surgeon at OrthoIndy near Indianapolis. “She’s in her late 30s trying to deal with three young children at home while also trying to deal with lots of pain in her legs.”
The prohibition has also delayed cancer screenings. Screening appointments for breast, cervix, and colon cancer plummeted between 86% and 94%, according to data from Epic, an electronic medical records vendor. The IQVIA Institute for Human Data Science projects that up to 80,000 cancer diagnoses will be missed or delayed between March and June.
Trying to make up those missed screenings presents new risks.
“I’m terrified that some of my patients that we’ve had to delay treatment for will fall through the cracks,” said Madrigal Dersch. “I have one patient who needs a thyroid biopsy and couldn’t get it right away. I’m worried that with the delay, she might think it’s not important, or that she’ll forget to get the biopsy, or the testing place will lose the referral, and then a year from now, I’ll find out she had cancer that needed treatment.”
The delays also harm patients’ mental health.
“The amount of stress on people right now because of the pandemic is difficult and, at times, devastating. That stress is made more severe by being in pain and having limited function,” said Dietz.
“We see a lot of anxiety,” Madrigal Dersch said. “One patient I saw had a mass on her abdomen, and we have to wait to have it excised. She’s been calling me every day because she’s so stressed. And the stress is causing her to think she has more symptoms, and that makes it hard for me to tell what is real and what is not.”
In some cases, the pain and stress lead to another problem, that of opioid addiction. A recent survey commissioned by the Recovery Village, an addiction treatment center, found that 36% reported an increase in illicit drug use.
“We already had a problem with opioid addiction before the pandemic, and this is not helping,” said Dietz. “I have the patient in her late 40s who has become addicted to narcotics because we had to delay her surgery. We are now getting her help so we can hopefully eliminate her use of narcotics before her surgery.” He emphasized that people who are using narcotics prior to surgery often have much more pain after surgery, making it harder to get them off the drugs afterward.
In recent weeks, more governors have lifted the prohibitions on elective surgery. That should provide some relief to hospitals that have suffered financially. Elective surgeries make up a significant portion of hospital revenue, and in March alone, hospital revenue declined 13% from the previous year. This has resulted in 1.4 million healthcare workers losing their jobs. Prior to the pandemic, the healthcare sector was widely believed to be recession-proof.
Yet, lifting the prohibitions does not necessarily mean an opening of the elective surgery floodgates.
“Right now, my associates and I are trying to keep patients who are most at risk from the virus out of harm’s way,” said Dietz. “That’s the patients over 65, and they are the majority of my patients. They are still waiting, and right now, there is no point in time where we can tell them that things will be ready for their surgery.”
