Why are surgeons not operating

Why do doctors refuse to see regular patients now and avoid routine non-emergency surgeries?

The whole of India is standing still since March 25 this year due to the Corona pandemic and all modes of public transport have come to a stop. This is a totally unprecedented situation that I have never seen in my five-plus decades of life. Even during the times of war, the country didnt come to a halt like this.

Then why now?

Here the enemy cant be seen and can still kill us. When HIV came to prominence in the eighties, I remember the fear we all had as medical personnel then. But HIV could spread in only a few specific ways and not definitely by cough or sneeze. We all take routine universal precautions and do attend to all patients. We make sure that we do not ostracise them and create stigma.

The new corona contagion is deadly and not taking precautions means that doctors, nurses and every health care worker is at the risk of contracting the virus. There are certain procedures and surgeries that create lots of aerosols – the microparticles in the air with the germs in the closed atmosphere of operation theatres with closed air circulation, everybody in the operation theatre is at risk.

Cancer and Emergencies

Definitely, doctors are not shying away from their duties. Every life-threatening emergency like heart attack, stroke, acute appendicitis, cholecystitis (gallbladder inflammation due to stones) is attended to immediately putting every health care workers life at risk. We categorize the surgeries as per the risk involved and accordingly take appropriate precautions and do the surgeries. Routine surgeries also need ICU admission and we dont want to hold up ICU beds which may be needed for critically ill COVID-19 patients.

It sometimes gets difficult to identify COVID-19 in asymptomatic patients and there is an increased risk of mortality in COVID patients who undergo routine surgeries. However, cancer and emergency cases where the risk of death is higher when prompt treatment is not undertaken means that certain surgeries can never be postponed.

The question is how long can we put away routine surgeries?

Life is slowly limping back to normal despite the increasing cases. We are finding it difficult to postpone semi-elective cases. Life will definitely not be normal for the next few months till the pandemic subsides. We are slowly resuming surgeries with very high levels of precautions. Time will tell us if these precautions were adequate.

The ultimate aim of healthcare is patient safety and patient wellness. There can be no healthcare model that compromises on these principles. Resuming routine surgeries can only be done if the patients interest is not compromised. I operate on hernias and gall bladders for a living. If a surgeon refuses to operate on you, you should understand that there might be some logic in their decision. 30 years of having spent most of my life operating have taught me that there can never be good outcomes when ethics and integrity are sacrificed.

Patient responsibility

Patients have the responsibility of not undergoing avoidable procedures in these crucial times. There will always be some surgeons willing to operate on you but do realize that here the casualty is not just you or your family but the entire community. It is the responsibility of every citizen to maintain social distancing norms. The hidden enemy can be won only by these measures.

Love,
Dr (Major) R S Rengan MS, DNB, FAIS, DLS (France)
Consultant General, Laparoscopic and Hernia Surgeon
Founder & Chief Surgeon HoH Surgical Centre & Chennai Hernia Centre