Concern at the effect of Dunedin Hospital elective surgery postponements on patients with chronic conditions has been raised by a young woman in that situation herself.
The woman, who did not wish to be named, said she had to stop her arthritis medication three weeks before the date of her recent planned ankle surgery.
She was advised a day before the surgery that the hospital was full with no beds available and she would be advised of a new date.
The woman said a receptionist rang to tell her this but did not know what to advise her about her medication.
Patients whose operations were postponed should receive proper advice about their medication from a doctor or a nurse, she said.
It did not take long for her health to deteriorate when she was not taking her drugs and the longer she was off medication "the worse it gets".
She expected there would be many other people, often elderly, with chronic conditions who would also be disadvantaged by having to come off medication, possibly several times, while they waited for an operation.
Often, they would be too scared to complain about such poor treatment, worried that services might be taken away from them.
The woman said after waiting more than one and a-half years for the surgery, the psychological effect of the delay was immense and there seemed to be no consideration of that.
"Anger has been a big thing with this."
Although she had recently completed vocational training, she was not able to work because of the discomfort of standing. Her life was "on hold" until the surgery was completed, she said.
She had been "counting down the days" to her planned surgery date.
People waiting for surgery were often "desperate" to have it done and had been waiting a long time for procedures which would make much difference to their daily lives.
Emergency medicine and surgery group manager Dr Colleen Coop said the issues raised by the patient affected services differently.
In general surgery, depending on when the postponement occurred, a surgeon or clerical staff member could phone the patient. The latter was usually followed up with a call from a clinician.
In general surgery a new date was usually able to be given and advice regarding medication would be given at that time.
For general surgery, plastic surgery and urology there were fewer medications which had to be stopped.
However, in orthopaedics, although last-minute surgery postponements were always undesirable and never undertaken lightly, the lack of acute operating time meant they were frequent.
An extra 35 hours a week for acute surgery had been approved and a plan for its introduction was being developed, she said.
When postponements were necessary, the priority was to notify patients as soon as possible, and then look at rebooking once all had been advised. This meant it was not possible to give patients a new date on that call, Dr Coop said.
When patients asked about what to do regarding medications, the orthopaedic service generally asked concerned patients to contact the prescriber, usually their family doctor, or to continue with their regular regime if they had no concerns.
Rebooking advice included following the original instructions regarding medications.
The woman waiting for surgery was also critical of the organisation of the pre-admission clinic which she had attended four days before her surgery.
She had spent six hours at the clinic, much of that time waiting to see the relevant people.
While she appreciated Dunedin Hospital was a teaching hospital, much of her interaction with staff at this clinic involved repeating answers to questions already asked, she said.
Better co-ordination of such clinics and improved communication between hospital departments would help speed things up.
She said she felt sorry for surgeons having to work in such difficult conditions and believed if the hospital wanted to "keep top surgeons then they need to address the lack of surgical space".
While she has been allocated a new date for surgery this month, she is concerned the operation might not proceed on that date either and is exploring other options.
Dr Coop accepted pre-admission clinics were long and patients were advised it could take four to six hours.
At some clinics, there could be 10 or more patients, all of whom had to see a nurse,house surgeon, anaesthetist and consultant.
Some might also have to go for other tests, including X-ray.
The nurse was the only person based in the clinic and everyone else visited.
House surgeons needed to juggle the needs of the inpatients with attending such clinics and they also had many discharges which needed to be done in a timely fashion to free up desperately needed beds, or sick patients who had to take precedence.
On the matter of repeated questions, Dr Coop said while it might seem like the same question, each health professional was asking it from a different perspective and purpose and would be looking for different things in the answer.
"The medical staff view is that they have a duty of care to the patient and cannot rely on what someone else has written.
"If vital information is missed, they would be failing their duty," she said.
