Doctor Explains Decisions To Delay Elective Surgeries
SCOTT SIMON, HOST:
Surgeons around the country have had to make critical decisions about which elective surgeries must be cancelled or postponed during the pandemic. From gallbladder surgeries to tumor removal, some patients have been told to just wait. Dr. Daniel Buckland is an attending physician at Duke University Hospital's emergency department. Doctor, thanks so much for being with us.
DANIEL BUCKLAND: Thank you for having me.
SIMON: And help us understand what facts you have to balance to decide whether to delay or cancel an elective surgery.
BUCKLAND: So as an emergency room doctor, I don't usually decide when things are canceled or not. But the balance is often between what needs to happen right now and what should happen but can get a little bit more planning and safety in terms of optimizing the health of the patient to allow for - surgeries are rough to do, and so the most preparation you can have, the better. And emergency surgery's always - are always less than ideal. So any planned surgery is also called elective, which isn't often the term used in the same way most other people use it. So elective just - in our kind of world - just really means not emergency.
SIMON: It doesn't always mean, for example, you know, an eye tuck?
BUCKLAND: Right. Yeah. I mean, so like there's the cosmetic surgeries, or stuff like that, which also fell in the bucket of elective. But when we talk about elective, I'm meaning - like you mentioned in your intro - a gallbladder surgery. A gallbladder surgery - if it's an emergency, can be a dangerous procedure. If it's not an emergency, the problem that's causing the pain and vomiting of an obstructed gallbladder is still there. It's just something that can be temporarily delayed by a change in diet or medications or antibiotics. But it's still going to get inflamed and obstructed pretty frequently. And that makes you have to come back to the emergency room for this temporizing treatment over and over again until it gets bad enough that it's an emergency surgery.
SIMON: Well, with all due respect to difficult decisions that have to be made, are there surgeries being delayed now in the pandemic that, in the best of all possible worlds, would go ahead for the relief and best health of a lot of patients?
BUCKLAND: Yeah. I mean, so the balance that we were trying to strike at my institution, at Duke, was making sure there was enough protective equipment for the emergency procedures to go on - both in the emergency room where I work, seeing the coronavirus patients as they come in and getting sicker, and in our ICUs and in the rest of the hospital. And then to allow them to also do these needed but not as emergent needs surgically to happen.
SIMON: What do you tell a patient?
BUCKLAND: Often, there's a lot of apologizing. And most - all the patients have been very understanding. Everyone has been like, we know what's going on. And often, some of them - and this has also been in the news - have been just flat out scared to come to the emergency room because they're worried that we're too overwhelmed to take care of their needs or that they're going to pick up the coronavirus itself.
SIMON: Are there cancer procedures - are there heart procedures that are being delayed?
BUCKLAND: Yes, very much so. Yeah. Cancer, heart, obstetrics, gynecology, orthopedics, surgical subspecialty broadly are not doing - the only ones that I saw were still happening - and even then was with a lot of thought - were transplant procedures because an organ only lasts for so long. And you really didn't want those people getting sick. And so a lot of resources and protective equipment was being used to allow these things to go on.
SIMON: I wish I knew another way to put it. But it must be frightening for someone with a heart condition or with cancer to be told, we've got to delay your surgery.
BUCKLAND: Yeah. I mean, especially if this is something - a procedure they've been waiting for because of the ways the medical systems in the U.S. work. If a delayed surgery that they've been waiting for was already scheduled, it's frustrating to then be told no, you now need to wait. And now I don't know how long you need to wait for a surgery that the doctors have told you you need to either live or to work and do your activities of daily living. And I'm on both sides of this. My son has been waiting for a procedure that was supposed to happen when they canceled all the surgeries. And so we're also waiting.
SIMON: May I ask you what kind of surgery your son needs?
BUCKLAND: It's a tonsillectomy. It's not an emergent thing. It doesn't need to happen tomorrow, but it does need to happen.
SIMON: Do hospitals and doctors just need to figure out how to do more than one thing at a time?
BUCKLAND: Yeah, and I think they are learning how to do that right now. So, again, my institution is - like many institutions nationally - are trying to figure out, OK, we have these resources we have. And how do we now reshare them? And they're reassessing every day what surgeries need to happen and gradually opening the bounds of what is a surgery that should happen or not as we kind of get a handle on what resources we have and are getting. And I think a lot of this - at least as a frontline provider, the frustration is what's communicated to us both through the national news and through institutional news, we don't know - how secure are the supply lines, right? Are we going to continue to get the right amount of equipment? Because it's a different cost-benefit analysis if - oh, we don't know how much protective equipment we're getting, and these virus patients are still coming. So then I would defer more on the less surgeries.
SIMON: Dr. Daniel Buckland is an attending physician at Duke University's Hospital emergency department. Doctor, thank you so much for being with us.
BUCKLAND: Thank you.
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