Beyond the knife: How public hospitals are diverting patients away from surgery and into therapy

Public hospitals are slashing their surgical waiting lists by up to 70 per cent by diverting patients to physiotherapists for non-invasive treatments for their backs, knees and hands.

Since late 2022, more than 4600 patients have avoided surgery at 23 hospitals across Victoria, including the Royal Melbourne, Barwon Health and Goulburn Valley Health.

Pauline Anderson avoided surgery and is finally pain-free after treating her lower back with physiotherapy at a major Melbourne hospital.Credit: Photograph by Chris Hopkins

Last year, the Royal Melbourne Hospital removed 31 per cent of the patients on its hand surgery waiting list by referring them to a team of in-house hand therapists.

The previous year, as it investigated creative ways to catch up on a lengthy surgical waitlist exacerbated by the pandemic, it diverted 70 per cent of patients from the same list to hand therapists. These patients were provided with home exercise programs, education and splints to resolve symptoms associated with carpal tunnel syndrome, trigger finger or thumb arthritis.

This meant they no longer required surgery.

A team of senior physiotherapists at the hospital who triage back, neck, hip, knee and shoulder pain helped a further 1500 patients avoid surgery last year. Just 78 of the patients in this cohort – who had been referred to the hospital for surgery by their GPs – ended up being transferred to the surgical team.

“We have a really high rate of success with managing patients conservatively,” said Caitlin Farmer, the hospital’s advanced practice physiotherapy clinic lead.

“If you’ve been referred to a surgeon by a GP … you feel like you are on this pathway to having surgery but when someone says, ‘actually here’s this alternative and it’s much less invasive and less uncomfortable’, they’re really happy to at least give it a go.”

After experiencing excruciating back pain for four years, Pauline Anderson feared her private surgeon’s next recommendation: a $50,000 spinal operation.

The constant pain, which radiated from her lower back to her right leg, had forced her into early retirement from her job as an aged care nurse.

But a referral to the Royal Melbourne Hospital from her GP led to the 63-year-old avoiding surgery entirely. The Brunswick West resident completed 12 weeks of free therapy under the guidance of a physiotherapist in the hospital’s back clinic.

She learnt how to lift weights, do leg presses, squats, use resistance bands and ride an exercise bike and was given exercises to complete at home. Anderson immediately noticed a difference in her back, and no longer needs painkillers or surgery.

“It has been the greatest experience,” she said. “I was in agony and now I can do everything. I’ve got my strength back. I’ve learnt how to use my core muscles to stand up straight. Exercise and movement is the best cure.”

At Barwon Health, around one in four patients on the hospital’s wait list for hand surgery have been diverted to hand therapists who have helped to resolve their symptoms.

Occupational therapist Bernice Mills, the clinical lead of Barwon Health’s hand service, said avoiding surgery reduced patients’ risks of complications such as infections, led to less lost time off work and saved the public health system money.

“Patients often comment that they weren’t aware that there was an alternative to surgery,” she said.

The recent growth in non-surgical treatments is a result of new patient support units introduced by the state government in late 2022 as part of an overhaul of planned surgery.Credit: iStock

Patients who access the service, which was set up in 2023, attend around four sessions with hand therapists and are given exercises to complete at home, as well as a splint to manage their condition.

According to orthopaedic surgeon Dr Ian Harris, orthopaedic surgeries are often no better at alleviating pain than non-surgical treatments, such as exercise programs, which are less expensive and safer.

“The whole system is incentivised toward procedures over prevention and non-operative care,” said Harris, who is also a professor of orthopaedic surgery at UNSW Sydney.

“There’s often a lack of acceptance of non-surgical or preventive treatment. For a lot of musculoskeletal conditions like back pain and knee osteoarthritis, the best treatment for the patient by far ... is to lose weight.”

He said surgeons operated on patients because they believed it to be effective, without realising that many of their patients would have also gotten better without surgery.

“When they operate, most of the patients are happy, so they keep operating,” he said. “They don’t realise that for many procedures, if they didn’t operate, the exact same number of patients would be happy.”

The recent growth in non-surgical treatments is a result of new patient support units introduced by the state government in late 2022 as part of an overhaul of planned surgery.

The units, which are located at 23 hospitals across Victoria, divert patients to more conservative treatments while also helping patients prepare for their procedures.

“Victoria is leading the nation in delivering planned surgeries faster thanks to our significant investment and focus on increasing non-surgical treatment pathways - ensuring people get the care they need,” Health Minister Mary-Anne Thomas said.

Opposition health spokeswoman Georgie Crozier said that while she supported moves to divert patients to non-surgical treatment, it wasn’t making a dent on the surgical waiting list.

“There are over 60,000 Victorians still awaiting surgery,” she said. “There are still far too many people waiting and having their lives on hold while they languish in pain.”

Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.