For the foreseeable future the coronavirus Covid-19 pandemic is going to continue to affect the way we have to live. Throughout the crisis, there has been some anxiety about how to access medical services. If you are worried about a bone or joint condition and think a consultation would help, we can make the arrangement for our consultations at a time that is most convenient for you and by whichever method you prefer.

I am writing to reassure you that traditional “face to face” consultations are still available and all recommended Covid-19 security measures are being used by me to make them as safe as possible. I am currently seeing patients “face to face”, but if you would be more comfortable to hold the consultation via zoom, or telephone then that can be easily arranged.

I have access to rapid access scans and xrays to enable confirmation of your diagnosis within a week. The facilities in which those would be carried out are also practicing all recommended Covid-19 security measures to make them as safe as possible

Insurers are funding zoom and telephone consultations as well as the more traditional face to face clinic reviews and have assured us they will reimburse for any tests or imaging which is still permitted during this crisis. I am recognised by the PFA, BUPA, Axa PPP, Aviva, WPA, Vitality etc. For insurers to fund outpatient visits, most still demand a referral by your GP or Club Doctor. If you are self-funding your outpatient visit, then although a GP referral is preferred, it is not absolutely necessary.

There are increased risks in surgical interventions at the current time, due to the Covid-19 pandemic. The risk of death, should you contract Covid-19 around the time of an operation is increased in comparison to “normal” times. In patients catching COVID-19 19 around the time of surgery the overall 30-day mortality in one study was 23·8%; all-cause mortality rates were 18·9% in elective patients, 25·6% in emergency patients, 16·3% in patients who had minor surgery, and 26·9% in patients who had major surgery. Your individual potential risk will be discussed with you during your consultation and depends upon your age, any underlying health issues you may have and the kind of operation you need. The long term effects of Covid-19 infections are beginning to be understood and a significant proportion of patients are showing “long covid” issues.

Private Elective Surgery has restarted, and I have regular theatre access. All the staff you will come into contact with and I are being tested regularly to ensure we do not have covid.

Booking a theatre slot has become a little more complex now due to the mitigations required to make your operation as safe as possible. You will be swabbed for Covid-19 antigen and will need to isolate for either 3 or 14 days before your operation, depending on what kind of operation you need your personal requirements for mitigation will be assessed at the time of listing.

The probability of Covid-19 infection with a false negative preoperative test is reported to be around 1 in 1,400. The risk of a patient with an undetected infection being admitted for surgery and subsequently dying from COVID-19 is estimated at approximately 1 in 7,000. However, if an estimate of the current global infection fatality rate (1.04%) is applied, the risk of death would be around 1 in 140,000, at most.

At the time of writing, all those recommended rehabilitation specialists listed in the “Rehabilitation” page, are seeing patients face to face. As Covid-19 restrictions are limiting access to physiotherapy for some patients currently, the updated rehabilitation protocols, may also be useful to guide you if you cannot have the personal guidance of a physiotherapist.

Once again, I would like to reassure you I am still here to help. Please do not hesitate to get in touch if you think I can be of assistance.

References:

The theoretical mortality risk of an asymptomatic patient with a negative SARS-CoV-2 test developing COVID-19 following elective orthopaedic surgery. Nardeen Kader, Nick D Clement, Vipul R Patel, Nick Caplan, Paul Banaszkiewicz, Deiary Kader. Bone Joint J. 2020 Sep;102-B(9):1256-1260.

https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.102B9.BJJ-2020-1147.R1

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. COVIDSurg Collaborative. Lancet. 2020 Jul 4;396(10243):27-38. Free PMC Article

https://www.boa.ac.uk/uploads/assets/0150529d-1fa2-4741-9510d875e4c1a1d0/Patient-statement-re-elective-restart-Sept20-FINAL.pdf