The best time to have an operation

A report in the Canadian Medical Association Journal says it’s much safer to time your sickness. If not, there is a good risk of ending up with inferior medical care. So when should you get ill? And what is the prime time to have an operation?

Jesse Gruman, president of the Washington, DC. based non-profit Center for Advancing Health, says, “Anybody who’s been in hospital knows that it’s a kind of banker’s hours after six o’clock. You feel really vulnerable if something happens at night because of the sparseness and responsiveness of the night staff.”

But is this also a problem in Canada? Dr. David Wilson, president of the Canadian Society of Hospital Medicine, isn’t reassuring. He says, “In comparison with the U.S., I don’t think that after-hour coverage is as well funded in our country.” No one who has spent a night in hospital would disagree with these opinions.

Wilson adds that, “Canada’s single-payer health care system makes it more difficult to provide financial incentives.” So it’s often the luck of the Irish if you happen to receive the same care after-hours as before-hours.

Since none of us can decide that a ruptured appendix, broken leg or heart attack will occur during the day, what can be done to decrease the risk of after-hour neglect?

Trying to fix this Russian Roulette game of night-time care isn’t easy. But some U.S. hospitals have turned to “nocturnists”, doctors who come to work at night, expect to be there all night and work all night.

Other hospitals, such as the Vancouver General, treat after midnight medical issues by telephone, managed by a critical care outreach team or by the most responsible physician. How effective these measures are when dealing with emergency situations is questionable. Besides, it’s not just surgical emergencies or heart attacks that occur after hours. For instance, it would be interesting to know how many patients who desperately cry out for a bedpan during the night receive one only after it’s too late.

The report in the CMAJ reminded me of Arthur Hailey’s best selling book Wheels. Hailey warned his readers not to buy cars built on Monday or Friday. Monday’s cars, he said, had a bit of weekend hangover built into them. Friday’s cars often lacked nuts and bolts left out by a worker anxious to get away for the weekend.

But what about surgeons? Are they more reliable than autoworkers? Or are they too more likely to leave a sponge or instrument in the abdomen on a Friday or after-hours? If so, what is the best time-slot for an operation?

Like Hailey, I’d prefer that my gallbladder or bypass operation didn’t happen on a Monday or Friday, for the same reasons. I’d also be less concerned if it was performed early in the day as surgeons are not robots. They are subject to fatigue like everyone else.

So, for me, prime time is Tuesday at 8 a.m. The first operation starts on time. Later in the day surgical emergencies may occur and scheduled operations have to be cancelled or delayed. This rarely happens at 8 a.m.

A Tuesday booking has one other advantage. If a complication occurs, the surgeon is usually available for the rest of the week. If it happens on Saturday, you may be treated by another surgeon less familiar with your case.

Remember, this is not an ideal world so I doubt that night-time care will ever be as good as daytime. Nor can everyone expect to have what I consider prime time surgery.

But let me leave on this reassuring note. Maybe Hailey is right about cars. But I’ve done enough nighttime surgery to know that 99.9% of the time after-hours care does not differ when a patient’s life is at stake. Doctors, anesthetists and nurses always gear up to become as efficient as possible when a case is critical. Medicine continues to be the most noble and caring profession of all.

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