Referral Process

1 Do I need a referral to see a doctor?

Yes, a referral is required for consultations with an orthopaedic surgeon.

2Why do I need another referral after 6 months if I’ve seen the doctor before?

Referrals are only valid for 6 months after your last visit with the surgeon. If it has been longer than 6 months a new referral is required.

3Is my visit covered by my provincial medical coverage?

Yes, all non-expedited consultations and surgeries performed by ROCC physicians/surgeons are covered by BC medical. Braces, certain injectables and expedited services are not covered by BC medical.

4What is the ROCC? Do I have to be seen there or can I see the surgeon directly?

ROCC is the Rapid Orthopaedic Consult Clinic. It was set up by POSM surgeons to facilitate orthopaedic care of patients in the Coastal Health Region. This allows patients to be seen by an expert in orthopaedic care much faster than if they had to wait to see one of the surgeons. Non-operative management, treatment and education takes place in this clinic. If you are a surgical candidate and fail non-operative management you will be referred to one of the POSM surgeons for a consultation.

You may choose to see the surgeon directly but the wait for most of the POSM surgeons for a public consultation is 8-12 months. Seeing a ROCC physician allows a more rapid access to orthopaedic care and, if you are a patient requiring surgery, allows for the ROCC physician to begin the work-up (e.g. appropriate MRI, CT, X-rays, lab tests) so that your care is not delayed.

5Can I choose my surgeon after being seen at the ROCC?

The goal of the ROCC Clinic is to streamline patient care and allow for patients to see the surgeon with the shortest wait time for patients. However, if you wish to wait for a particular surgeon, you may choose to do so.

6Where is my appointment?

ROCC Clinic appointments are at our North Vancouver office. Your surgeon may see you at multiple locations. Please listen carefully to the instructions provided by the medical office assistant.

7Why do I have to be seen at the cast clinic?

If you are a trauma patient or a post-operative patient you will be required to attend the cast clinic. This clinic has the appropriate staff and resources for wound assessment and management, casting and splinting as well as pre and post-surgical management for trauma patients.

Please be advised that for all the POSM surgeons this is a very busy clinic and as a result of the fluctuating numbers of patients injuring themselves week to week and day to day, the surgeons have limited control over the number of patients in each clinic and as a consequence patient’s may end up being seen significantly later than their booked appointment.

8Why do I have to be seen at the JRAC?

The JRAC or Joint Replacement Access Clinic is a focused subsidized clinic that allows patient’s access to streamlined care involving physicians and nurses. This allows more efficient processing of patients with arthritis and improves preparation for surgery and post-surgical management.

9How do I get there and where should I park?

There are several locations that surgeons see patients, please listen carefully to the instructions provided by the medical office assistant.

10How long will my appointment take? Why is the doctor so late?

It is difficult to estimate the exact amount of time each visit will take as it will depend on a number of factors outside of the control of the physician or surgeon.

Some appointments require X-rays which can increase the appointment length significantly. If you have a visit in the cast clinic it is important to note that it is a very busy clinic and the X-ray department is very busy as well. The number of patients seen in each clinic depends in large part on the number of patients injured in the recent weeks and is largely out of the physicians control. Waits between 1-2 hours are common. You may be able to decrease your wait time significantly if you are able to get imaging performed the day before or at an outside clinic. Ask the medical office assistant if you are a candidate for early or offsite imaging.

11Why is the wait to be seen in consultation so long?

Unfortunately, there is a far greater need for orthopaedic care in the coastal region than there are orthopaedic surgeons leading to significant waits for many patients. POSM is trying to improve the access to care with the ROCC Clinic which has significantly improved the wait time for patients to see an expert in orthopaedic care or sports medicine.

12I’ve already had X-rays and/or MRI, do I need new X-rays?

Yes, in most cases. Your surgeon will request new X-rays if your films are older than a couple of months. Additionally, orthopaedic specialists often order different X-rays than other physicians in order to adequately assess your orthopaedic disease.

MRI and X-rays are different and show entirely different aspects of anatomy. X-rays will almost always be necessary even if you’ve had an MRI.

13Why is it so hard to get a hold of someone at the office?

The doctors at POSM run very busy practices that keep their medical office assistants very busy. Please take note of the office hours and ensure that you contact the office during those hours.


Surgery and Post-operative Care

1What conditions do you treat? What surgical treatments do you provide?

Orthopaedic surgery is a diverse field and the majority of surgeons in medium to large size cities in Canada have a focused sub-specialty practice. Please see our Surgeons page for full biographies.

  • Mark McConkey: Complex soft tissue knee reconstruction (ACL, PCL, knee dislocations), osteotomies around the knee, hip arthroscopy and impingement surgery, shoulder arthroscopy and soft tissue reconstruction, sports medicine, trauma
  • Victor Jando: Primary and complex total hip and knee arthroplasty, knee arthroscopy and ACL surgery, sports medicine, trauma
  • Alan Baggoo: Foot & ankle surgery, total knee arthroplasty, knee arthroscopy, sports medicine, trauma
  • Kostas Panagiotopoulos: Primary and complex total hip and knee arthroplasty, knee arthroscopy and ACL surgery, sports medicine, trauma
  • Shannon Samler: Shoulder arthroscopic surgery, soft tissue reconstruction and total shoulder arthroplasty, knee arthroscopy and ACL surgery, sports medicine, trauma
  • Adam Sidky: Primary and complex total hip and knee arthroplasty, knee arthroscopy and ACL surgery, sports medicine, trauma
  • Peter Zarkadas: Shoulder arthroscopic surgery, soft tissue reconstruction and total shoulder arthroplasty, elbow arthroscopy and reconstruction, knee arthroscopy and ACL reconstruction, sports medicine, trauma
2What is arthroscopic surgery?

Arthroscopic surgery is a procedure done through small 4-5 millimeter portals in your skin. This ‘keyhole’ surgery allows the surgeon to insert a camera into the joint and using special instruments can diagnose and treat a large number of conditions. Examples of arthroscopic surgery done by POSM surgeons include ACL reconstruction, meniscal surgery, rotator cuff repair, shoulder dislocation reconstruction, ankle arthroscopy and hip arthroscopy for labral tears and impingement.

3What is joint replacement surgery?

When a joint has significant arthritis and the patient is disabled with pain, surgeons can excise the diseased joint and insert a new joint made of synthetic material (usually metal and plastic). Joint replacement surgery is very common especially in the hip and knee.

4What is my new joint made of? Are there different options?

Most commonly, total joint replacements (or arthroplasties) are made of metals such as cobalt chrome and titanium, and very hard, durable plastic called polyethylene.

There are different options that you may have heard of or read about on the internet. These options are limited to hip replacements at this time. These include ‘metal-on-metal’ hip replacements which have come and gone in popularity several times over the decades. There are also ceramic hip replacement which involve either a ceramic ball and socket or a ceramic ball with a plastic socket. Please ask your surgeon if you have questions about these types of surgeries.

5Can I have my joint replacement surgery in a private facility?

Total hip and knee replacement surgeries are currently not available at any private facilities in BC. Partial knee replacements and total shoulder replacements surgeries are the only forms of major joint replacement currently available privately in BC.

6I had orthopedic surgery and have metal in me. Do I need a note to get through airport security?

No. In the past patients were provided information cards to give to security officers at the airport indicating the presence of an orthopedic device. These are generally no longer accepted so they are not provided.

7I am about to run out of pain medication. Can I have a refill or do I need to go to my family physician?

Each surgeon runs their office in different ways. However, any requirement for pain medication on a chronic basis (typically greater than 2-6 weeks post op) will require you to visit your family physician. Most orthopedic specialists will provide you with pain medication for the early post-operative period but then require you to visit your family physician for long term care and medication.

8Do I need physiotherapy? If so, when should I start?

Physiotherapy is often required after orthopedic surgery. When to start physiotherapy will depend on your condition and will be discussed with you by your surgeon. Please note that BC medical generally doesn't cover physiotherapy costs.

9When can I drive?

This depends entirely on your condition, please discuss this with your surgeon.

In the event of motor vehicle accident, please be aware that you may face challenges in proving that you were not impaired in any significant way as a result of pain or the side effects of medication.

There are some general statements that apply to everyone:

  • You may not drive the day of your surgery. You also cannot take a taxi home. You must have someone to drive you home.
  • You may not drive while taking significant narcotic medications for pain management.
  • You may not drive with a cast or orthopedic boot or brace on your leg.
10When should I go back to work?

This depends entirely on your condition and your work requirements. Please discuss this with your surgeon at a follow-up visit.

11Do I need a cryocuff/icing machine after surgery? Will my insurance cover it?

A cryocuff is an automated continuous cooling unit that circulates cold water from a cooler to a special pad secured over a dressing or other skin protective barrier. This unit provides excellent cooling and compression which helps with post-operative swelling and pain. Access to a cryocuff is very helpful for patients in the postoperative period and if available you should take advantage of it. However, there are costs associated with these devices and a similar effect can be achieved with diligent use of ice packs.

BC medical will not cover these devices but most 3rd party insurance companies (e.g. extended benefits) do cover them. Please ask the medical office assistant to provide you with information so you can ask your insurance company prior to surgery.

12Do I need to purchase a sling before my shoulder or elbow surgery? Will my insurance cover it?

The hospital will provide you with a nylon sling after surgery. Most shoulder procedures will require you to wear a sling for 6 weeks. These nylon slings are not particularly comfortable and often start to break down before the 6 week mark.

There are higher quality slings available which are more comfortable and more durable. These slings may be a good option for you. Please ask your surgeon's office for recommendations.

For certain patients, especially patients with large rotator cuff tears, a special post-operative sling is not just a luxury but may help decrease the risk of re-tear after surgery. Ask your surgeon or their office if this sling is appropriate for you.

These slings are not covered by BC medical and cost anywhere from 40-160 dollars. The majority of 3rd party insurers (e.g. extended benefits) will cover a large part of the cost.


Trauma Surgery

1I broke a bone (or otherwise injured myself) and need surgery when and where will it be done?

Lions Gate Hospital is a high volume orthopedic trauma center and the surgeons prioritize patients according to the type of injury and the severity of that injury. Sometimes, patients may wait several days for surgery. The surgeons are aware of you and the short wait will not compromise your ultimate outcome. Learn more about Trauma Surgery.

2Who will do my surgery?

There are 7 full time orthopedic surgeons at Lions Gate Hospital that provide trauma coverage. They all have extensive training in orthopedic trauma surgery and perform hundreds of trauma procedures a year. Due to the high volume of trauma surgery performed at Lions Gate Hospital there is a good chance that the surgeon you met prior to surgery will not be the surgeon performing surgery.

3It has been several days and I still have not had surgery, I am worried I will not heal properly.

It is not uncommon to have to wait several days for surgery due to the prioritization necessary at a busy orthopedic trauma hospital. Your outcome will not be affected by this wait.

4I have been referred from the emergency department with an injury. Where and when will I be seen?

Each of the orthopedic surgeons at POSM run a cast clinic at Lions Gate Hospital every week. Your referral will be looked at by the surgeon on call when you hurt yourself and you will be seen within 1-10 days depending on the type of injury you have and the type of treatment that is anticipated.

POSM runs a weekly cast clinic at the Whistler Health Care Center on Saturdays. If this is more convenient for you please let the office know.

5What happens on the day of surgery?

If you are an outpatient with a fracture, the operating room will call you after 8pm to provide you with the date and time of your surgery. You may have to come in early for blood work. In most cases, if you are at home prior to surgery, you will be discharged from the hospital on the same day.

Typically, patients who are able to go home the day of surgery will be in hospital for a total of 4-8 hours. This can vary depending on the complexity of surgery, the patient’s medical problems and the response to anesthetic. You will need a friend or family member to drive you home. You cannot drive home or take a taxi.

6I am worried about a problem after my surgery. What should I do?

If you are significantly concerned about your well-being you need to be assessed by a physician. If you feel it is an emergency you should present to your local emergency department.

If your concern is less emergent then contact the office or your surgeon or go to your family physicians office.

7I was told by my family doctor or the emergency doctor that I need surgery. However the surgeon disagrees. Why?

Your orthopedic surgeon has a more comprehensive knowledge of musculoskeletal operative medicine. The surgeon will not recommend surgery if he believes that you will not benefit from an invasive procedure.

8I have a broken bone. Is there anything I should or should not do?

The specifics of each break (or fracture) are different and you should discuss them with your orthopedic surgeon. However, there are a few things that are known to negatively affect bone healing.

  • Unless you have been told differently DO NOT take anti-inflammatory drugs such as Advil, Ibuprofen, Naproxen, or Celebrex. They are known to slow healing and can cause bones to not heal in certain circumstances.
  • DO NOT smoke. Smoking is the most important contributor to bones not healing or taking a long time to heal.
  • DO make sure your diabetes is well controlled.
9Is there a way to speed healing of my broken bone?
  • If you have a normal North American diet, no special supplements or special dietary changes are necessary to speed your healing.
  • Most importantly, please follow the directions of your orthopedic surgeon in order to maximize your healing response.
  • There are certain fractures and certain patients that may benefit from a special ultrasound machine that has been proven to speed bone healing. You can ask your POSM surgeon if you are a candidate for this treatment.