Abortions, knee replacements: Doctors must decide which surgeries to postpone during coronavirus

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Doctors performing surgery. Photo credit: Pxhere.

Communities nationwide are scrambling to increase their resource capacity, bracing for a potential flood of coronavirus patients in the coming days. 

The Centers for Disease Control is recommending hospitals postpone or cancel elective surgeries. 

On today’s Daily Dose, Dr. Michael Wilkes, professor of medicine and global health at UC Davis, talks about what elective surgeries are, and what challenges health care providers face when deciding which surgeries to postpone. A lot of the decisions are based on resources.  

 According to Wilkes, there is no clear definition of what constitutes an elective surgery. Some procedures, like cosmetic surgery or routine colonoscopies, are easy to label as elective. But others, he says, aren't as easy to label. 

KCRW: Postponements can have significant effects on people's physical and mental health. What kinds of cases are you hearing about in your practice? 

“Orthopedic surgeries, hip replacements, knee replacements ... are being postponed. That means that people are going to be in pain for a bit longer. I've heard about prostate cancer surgery. Prostate cancer is a very slow growing cancer. But people get scared and they want it out,” he says.

Some postponed surgeries might have larger mental health implications, he says.

“Things like breast reconstruction, I don't think anybody would say that that's life sustaining. But for a woman who's had a mastectomy, that could be a huge psychological boost. ... Yesterday, a patient came in who was in tears. And she had just been told that she's a trans patient. [She] had been waiting 18 months for gender transforming surgery. It got postponed. Her concern was: What would happen afterwards as she now goes to the bottom of the list and has to wait 18 months again?” 

Why the postponements?

It’s to conserve resources, not punish patients, says Wilkes. 

“By resources, we mean hospital beds, making sure the hospital beds are going to be available for … critical patients who need them. Masks, as we've all heard, are in short supply. And gowns and oxygen. We also want to save our human resources, make sure that nurses and doctors and respiratory therapists aren't infected.”

State leaders in Texas, Mississippi and Ohio want abortions postponed or canceled. What reactions are you hearing in the medical community?  

“In California, there's outrage about this. There's no debate around the need for pregnancy terminations. These are essential. They're obviously time-sensitive medical procedures. … And we've seen, quite explicitly, that the politics of this, both in government and in anti-abortion groups … as an end run around abortion. Some states have even threatened doctors with jail time and large fines.”

He says that due to language around abortions – the procedure being a ‘woman’s choice – choice becomes the operative word: “If it's choice, then these states are saying ‘choice means elective,’ and they shouldn't be done.” 

But other states, he says, including New Jersey and Massachusetts, have explicity stated that when they do ban elective surgeries, the ban won’t apply to abortions. 

“Abortions don't waste hospital beds. They use very little personal protective equipment. And the majority of these procedures are done outside of hospitals. Furthermore, many abortions these days are done with medicines, not with surgical instruments. It's unclear – are these also forbidden? These procedures are timely, and they require timely attention. This is not the time for simply politics to enter into affecting women's lives.”