As post-Covid pile-up of cases sharply increases workload, doctors seek to prioritise surgeries

First, after the outbreak of the pandemic, the healthcare system’s focus shifted to Covid-19 cases and communicable diseases; this meant hospitals put on hold most cases related to non-communicable diseases.

The second factor was the fallout of the first: People began to stay away from hospitals for fear of catching an infectious disease.

And now, say the doctors South First met, ploughing through the backlog of elective surgeries has led to an increased workload for them.

Hospitals in the southern states have subsequently decided to prioritise such cases.

The pandemic effect

Doctors say that over the two years when the pandemic raged in India, people tended to neglect conditions such as diabetes, hypertension or renal disease, gynaecological diseases, and even cancer.

This was because people were scared of hospital visits, explains Dr CN Manjunath, director of the Jayadeva Institute of Cardiovascular Sciences and Research in Bengaluru..

Representational photo of a surgery in progress. (Creative Commons)

“The last two years have created a significant backlog of patients who avoided hospitals or the organised healthcare system for fear of catching a communicable disease,” Dr Manjunath told South First.

“This led to their neglecting non-communicable diseases.”

Plus, says Dr Rooma Sinha, a Hyderabad-based obstetrician and gynaecologist famed for her precision surgeries, hospitals decided to postpone elective surgeries both in the first and second waves of the pandemic.

This was normal, argues Dr US Vishal Rao, dean of the HCG Cancer Research Hospital in Bengaluru. “If you look at the global scenario, the entire focus globally shifted to communicable diseases,” Dr Rao says.

Increased workload

But as medical centres across the country grapple with their backlogs, it has led to an increased workload for doctors.

Dr Sinha admits to the added workload as a result of shelved cases.

“It (the backlog) is putting pressure on the healthcare systems,” she told South First. “At present, the number of surgeries I do is more than what I used to do in the pre-Covid days.”

The Hyderabad specialist’s daily routine currently involves about four to five laparoscopic surgeries and about two to three in robotic procedures. “The numbers were about half of these before the pandemic,” Dr Sinha says.

Dr Abhijit Vilas Kulkarni cites cath lab data to show an increase in surgeries at Apollo Hospitals, Bannerghatta Road, Bengaluru. “Our cath lab used to do 350 procedures per month, but now it is around 450. That is about a 33 percent increase.”

Surgery in progress. (Creative Commons)

Apollo Speciality Hospital in Jayanagar, Bengaluru, has witnessed a similar increase, Dr Kulkarni, who is associated with both hospitals, told South First.

HCG’s Dr Rao, a neck oncologist by qualification, similarly points to how the focus almost overnight shifted from communicable to non-communicable diseases, and reckons this has increased the workload “by about 30-40 percent”.

There is pressure on the healthcare system as a whole, he told South First. “Doctors, nurses and social workers all have to bear the brunt.”

Another Bengaluru hospital, Aster RV, has seen a “two- to three-fold” increase in elective surgery cases, according to its Lead Consultant, Orthopaedics and Joint Surgery, Dr J.V. Srinivas.

“This definitely puts a strain on the system,” says Dr Srinivas.

Managing the workload

So how does the medical fraternity plan to deal with the challenge? A doctor from Chennai, requesting anonymity for himself and his hospital, avers that the need of the hour is to prioritise cases.

“We have a backlog of elective surgeries, and the number of people waiting for cancer-related surgeries is huge. But we are managing to choose and prioritise the emergency cases.”

Aster RV’s Dr Srinivas advocates the same route. “Doctors now have to prioritise those who require surgeries urgently over those who can wait to put it off longer. This should hopefully ease out over the next six months,” he says.

Hyderabad’s Dr Sinha has faith in the city’s healthcare system, both public and private, that she describes as “robust” and trying to cope with the backlog and help patients at the earliest.

Aster CMI Hospital’s Chief Surgeon and Senior Consultant, GI & Bariatric Surgery, Dr Shivaram HV, harbours similar views for Indian doctors in general.

“Unlike in many other places, like the UK, doctors in India work for long hours and are capable of clearing the backlog,” says the Bengaluru doctor. “A large number of surgeries were done without much fuss.”

His view: The Indian healthcare system can absorb the burden without much difficulty.

And HCG is doing it too, maintains Dr Rao. His organisation has been working on optimising tele-health solutions even at the grassroots level, and also successfully reached out to cancer patients virtually to follow up on consultation, he says.

“We are seeing cases and numbers stabilising due to optimisation efforts,” adds Dr Rao. “The situation is fluid and will keep fluctuating over the next couple of months.”

How are the poor coping?

What doctors are concerned over is how the most vulnerable sections of society have knowingly ignored treatment – either because they cannot afford the procedures, or are afraid of hospital visits.

As Dr Rao says, citing ICMR reports, people most prone to mortality and morbidity during the pandemic were those with non-communicable diseases which include heart diseases, lung diseases and cancer.

The problem is paying for the resources, doctors say. For instance, Dr Kiran Madhala, head of the Anaesthesiology and Critical Care department at Government Medical College, Nizamabad, says there is no rush at state-run hospitals, but gives a worrisome reason for it.

“People in rural India are not coming forward for surgeries because they have drained their resources,” says Dr Madhala, who is also a national member of the All-India Federation of Government Doctors.

Echoes a senior doctor from a state public health centre in Karnataka: “People have fallen into severe debt and are unable to afford even government hospitals. They are not coming forward.”

His fear: “If government doesn’t pay attention to this, we doctors may be burdened with a flood of emergency surgeries soon.”