Making decisions about knee replacement as an older person with multiple conditions

I was very confident with the surgeon that I had and he was brilliant.

I did write a letter and thank everyone in the department. I mean when I phoned up to do the change of appointment, you know you could get through to the secretary, the bookings clerk, you could get through to everybody, they were really good

So I wasn’t, and the whole atmosphere at the hospital was just lovely. I think the staff were smiling, they’re relaxed, it’s really nice, it’s a fantastic hospital.

It’s nice for them to have the positive feedback as well, isn’t it? And to sort of know the success stories.

Well, I think so, it’s, you know they train for so long and they’re gifted people, and you don’t see them when you’re recovered kind of thing. I saw the head physiotherapist but I wouldn’t have seen the surgeon, but you know they make such a difference to people’s lives, it’s incredible.

I think once I’d seen a consultant at the [hospital], I'll stay there because the thing is about the things now, is the fact that I thought everybody could see everything about your-, like I'm talking about X-rays now, but the guy at [hospital], when I went first time, he couldn’t access the X-rays I’d had, and there was a lot of confusion because he said, “You're at [town],” and I said, “Well no, but I had the X-rays at [town],” “Oh,” he said, “I can't find them at all on the system,” so I don't think their systems talk to one another like they're allegedly supposed to do.

Because when I go on-, next time, I've had had the X-ray from when he did it, and they're I'm going to-, well, the first thing I do when I go for the appointment in January, is he’s going to X-ray it again, but he could have used an X-ray that I had done at [town], but he couldn’t find it, or couldn’t get it.

Possibly, and they probably do in a lot of instances, but I would say, you know, rather than just saying, ‘right, I'll give you these painkillers and we'll see how you go with those,’ is to give a list of, ‘right, what we'll do, we'll try the painkillers first for three or four months, then if you've had no relief from that, I think possibly we ought to try the injection, the cortisone injection and then you have 12 months on that and then we'll look at it again,’ or something along those lines to give people that bit more of an encouragement instead of saying, ‘well, you're too young to have it.’

If the surgeon said, ‘it’s going to be nine months, we’ll get in touch with you,’ it would have been nice if after, say, two or three months someone gets in touch with me, either emails me or sent something that, ‘we haven't forgot you, and you're still on the list,’ and stuff like that. I’ve heard nothing from the surgeon since October.

The doctor, I told you, over this triage thing, I’ve heard nothing from them. I phoned up in January, “You're on the list,” I’ve heard nothing from them.

And, you know, it’s- I think it’s wrong in some respects. Well, I know it’s wrong - they could get in touch with people saying, ‘yeah, you're still on the list,’ or ‘we won’t-' or ‘we haven't forgotten you.’

Like that woman did in [town] forgot to put me through to have a knee replacement.

I’m trying to remember, but I mean normally - and I’m not going to say this didn’t happen, but I can’t remember the surgeon coming into me and saying they were going to do this.

I definitely, definitely didn’t say a spinal, or anything like that, but he might have come in and just said, “Oh, you know I’ll take you down.” But I don’t even remember him coming into me, to be honest, to say that he was gonna do. Cos they normally just come in and have a word with you, don’t they? Before you go down.

And I don’t remember him doing that, but they certainly didn’t tell me I was gonna have a spinal epidural or whatever they were gonna do.

But when I went to the operating theatre there was a team waiting for me outside two anaesthetists, I think one was his junior, and two or three nurses, and I was taken in. And instead of being laid down on the bed to have my pre-op things and get ready to go in, they asked me to sit on the side of the bed and lean forward.

And I thought, well I’ve not had this before. Cos as I’ve said, I’ve had this done before - this was the third op, time I’d had it done.

And I asked what was going on? And they said, "oh we’re going to inject you in your spine."  Oh, and I thought, well that was, they haven’t done that before.

And so I leant forward, I did as I was asked, and the anaesthetist was quite abrupt. And then he started to get annoyed because he couldn’t get the needle in the right place in my spine, and it really hurt.

And after about the fourth or fifth time he got cross because I kept telling him it was really hurting, and I said to the nurse that was stood in front of me, “They do realise I’ve had spinal stenosis?**  Do they?” And she looked across behind - cos she was stood looking at me - she looked behind at the anaesthetist and she said, “No, I don’t think they do.”

And anyway, I said to her, “I’m gonna pass out in a minute,” because he tried again, and got very cross. Then I heard the junior anaesthetist say something quite sharp to the one that was doing the injections, or trying to.

And he tried once more and I said to the nurse "I’m going to pass out,"  And I passed, I leant to the right, or went on my right side and, to be honest I heard a bit of shouting and because I was right on the edge of the bed, I thought I was going to fall off the bed. But I just passed out and that’s all I can remember.

And when I woke up, I was in recovery.

Yeah, I mean, like the interview I had before the surgeon, before the surgery, especially about the spinal injection, perhaps to give them a leaflet? 

Because that, I think, because some people - I mean I have got a hearing aid, but I never wear it. And, and it’s stupid of me really but if someone’s in there and they don’t catch what’s said, or they just get the end of something, especially people my age, and there’s -

You know it, it would be nice if the surgeons, if they said like, you could have this, and give you a leaflet on it, and you can read it and then you can make your mind up whether you want that or not. You know? I would have definitely have said no anyway.

** Spinal stenosis is a term used to describe a narrowing of the spinal canal.

I think the most important thing is to remember to talk to the patient, and listen to the patient. Because as healthcare professionals, we're very good at listening to ourselves, but we're not that good at listening to what the patient has to say, and they are the ones who really know their body.

So even though it may seem not particularly appropriate at the time, they [the patient] can sometimes come out with something which afterwards gives you a clue as to what’s going on with them.

So, I think listening to the patient is one of the most critical things people should do.

And have you found that your doctors have been receptive to that from you?

Not always, no.

No.

You know, they tend to treat you like a silly old woman, or just a silly woman [chuckles].

Some doctors can be rather condescending, though the more modern ones don't seem to be, it’s a bit more some of the old-school, but - and I think it is important.

I hope that the medical profession sees things from a patient’s point of view. That they have put themselves in my shoes. You see. There is no them and us.

What I hope is probably will be like that, and I hope that you know and then at the same time they don’t look at it just as a, just as a task.

That it’s not a task or not, not a treatment or they’re not dealing with the symptom, but they’re also dealing with a person, you know.

And you know that they ask me, you know, that if I’ve got any concerns, or anything like that, or if I’ve got any, if I’m hesitant, why am I hesitant? You know.

And that they would put me, put my mind at rest.

To a consultant: just give as much information as possible, which I think they do they anyway to be honest, so that people aren’t afraid.

I mean, I've been to hospitals so many times and had so many things done, and they don't bother me anymore, but somebody that’s having a hip-, and that might be the first thing they've ever had done medically, I think, with surgery, they're going to be very nervous and they need constant reassurance.

If there’s anything good that can come out of this it’s to please ask the powers that be to - and I know that funds are limited and maybe they don’t have the staff, they don’t have enough physiotherapists - but people really need more physiotherapy. They really, really do.

Yeah, it’s, I know and it’s vital. And not only that, it’s not only good for the joint that’s been done but you need that to get up off your backside and keep your circulation going the way it should do. It’s good for your heart and everything else, but you just need more physio.

It’s tricky because I honestly- I do know that, [sighs]  the National Health is under a huge amount of pressure obviously, and it always is - let alone at the moment which is so much worse. So you can’t really say you ought to be seen by somebody earlier, but- [sighs] and maybe it is the way out for a lot of people, just the physio helps.

It obviously helps to keep you going to have the physio. I mean I think it’s probably very important, but maybe a slightly longer period of time with anybody that you see. If you're doing exercises at home, it’s very easy to get them perhaps wrong, that- not make the most of it.

Unless you're doing in front of somebody a number of times, rather than just once, to make sure that you're doing it properly—maybe it’s easy to not make the most of that opportunity.

I suppose that’s where people going privately are probably far better off because they’ll have a longer appointment, and they will be given perhaps rather more detailed instructions, not really walk away with a sheet of paper that is perhaps easier to misinterpret in some ways.

Maybe you suddenly discover, ‘oh gosh, well, I wasn’t actually doing it quite that way even though I thought that’s what it meant.’