How do I make a booking for a consultation?

The recommended way is to call my receptionist, Monique Kotzee, on 011 304 6784.

Alternatively you may email us at admin@drmatthee.com or use the form below and we will contact you.

    Get in Touch

    Please use the form below to get in touch with Dr Matthee's rooms. A representative will respond to you shortly.



     

    How should I dress for a consultation?

    A proper medical examination requires that the entire area being examined should be exposed.

    If you have a shoulder problem, I recommend a t-shirt that can be easily removed for gentleman. For ladies, a vest usually works best and can be kept on during the examination.

    If you have a knee problem, please wear shorts or bring a pair with you to change in to.

    We do have a few pairs of shorts in the rooms as well as a wrap-around gown that you may use in case you forget to bring something appropriate.

    *** Please do not apply any oils, creams or lotions to your skin before the examination ***

    What time should I arrive for my consultation?

    Please arrive ten minutes before your scheduled time. This allows plenty of time to fill out the required paperwork. If you arrive late and the next patient is ready to be seen, that patient will be seen first.

    How long is a consultation?

    If you are a new patient, you will be booked a half-hour appointment. This includes not only your assessment, but also analysis of investigations and discussion about treatment options. I like to make sure you have had the opportunity to ask all the questions you need to make important decisions about your treatment. You may require an X-ray, so please allow time for this, especially when the X-ray department is busy. Patients that have been seen and are returning from X-ray will be given priority – please do not assume that they have “skipped the queue”.

    Do you charge medical aid rates?

    For consultations and follow-up appointments I charge a private rate (as do most specialists). The consultation/follow-up fee must be settled in full on the day at the practice without exception. We do not accept EFT’s for consultation fees. We will give you a statement which you can use to claim back from your medical aid.

    With regards to surgical fees, I am contracted out of all medical aids with the exception of Discovery Health with whom we have a direct payment arrangement. This means that if you are on a Discovery classic or executive plan, we charge an agreed fee for surgery which will be covered in full and Discovery will make full payment directly to us. For all other Discovery plans we still charge the same fee, but there will be a shortfall for your account after Discovery has paid us a portion of the fee.

    For all other patients, whether you have a medical aid or not, we charge a private rate. This does not mean that your medical aid will not cover the cost of the procedure in full. Medical aids have a variety of plans to suit your budget and your medical needs. If you have one of the more comprehensive plans, the cost of the procedure may be covered in full, whereas with some of the budget plans there may be a shortfall that you need to pay in.

    Are there any additional charges besides the consultation fee?

    The consultation fee excludes any procedures performed in the rooms and also excludes any materials used (medications, needles, splints etc.). The fee for procedures and/or materials is added to your consultation fee and must be settled in full on the day of consultation. We will provide you with a statement for you to claim from your medical aid if this is applicable. Typical procedures and/or materials incurring additional cost are:

    • Cortisone injections
    • Application of casts and splints
    • Removal of metal pins under local anaesthetic

    The price may vary slightly according to the procedure and/or material used, but we can give you an exact price at the time of consultation.

    Is there a charge for follow-up appointments?

    Follow-up appointments are charged, but at a reduced fee compared with the initial consultation fee.

    If you have had surgery, all follow-up appointments for six weeks thereafter are included in the surgery fee. The exceptions are any further procedures and/or materials required during this period (e.g. a new cast) – this will be charged on the day of the follow-up appointment and should be settled in full on the same day.

    What payment facilities do you have?

    You are welcome to make payment by cash, VISA and MasterCard. Unfortunately we do not accept Diners Club or American Express. We do not accept EFT’s for consultation fees as this should be settled at the rooms in full on the day of the consultation.

    Do I need to have an X-ray?

    The X-ray is an essential investigation that all orthopaedic surgeons use to make a diagnosis and to plan or recommend the correct treatment. With very few exceptions you will need to have an X-ray at the time of your consultation.

    If you have already had an X-ray somewhere else, please bring it with you. If you do not, you may have to repeat the X-ray before I can help you. I may also need to repeat some of the X-rays if the pictures you have are inadequate or if there is a specific view that I need.

    Please note that some orthopaedic conditions require serial X-rays during the course of treatment.

    Please understand that even if your X-ray shows nothing abnormal, this in itself provides valuable information that may assist with the management of your condition.

     

    Do you have X-ray facilities at your practice?

    Yes we do!

    We have an X-ray machine adjacent to my consulting rooms. This has proved extremely convenient for patients visiting the practice as X-rays are usually acquired in a matter of minutes and available to me on the system immediately after they have been taken.

    The X-ray facility is a satellite unit and is operated by the National Radiology Service. If you have any queries, please contact them on (011) 304 6677.

    How much is an X-ray? Is it covered by medical aid?

    The X-ray department is not part of my practice, and I therefore cannot assist with any pricing information. This can be obtained from National Radiology Services (Inc) on (011) 304 6677.

    If you are on a medical aid, the majority of plans include a basic radiology benefit and in most cases the cost of the X-ray should be covered by your medical aid. If you do not have a medical aid, you will have to pay for the X-ray. This is billed separately by the radiology service, and is not included in your consultation fee.

    I

    Can I have a copy of my X-rays and/or the report?

    You certainly can. The radiology department can supply you with a hard copy of your report and an accompanying CD with your images. Please contact the National Radiology Service (Inc) on (011) 304 6677.

    We do not keep copies of your X-rays or reports and cannot provide you with these.

     

    What is an ultrasound scan? Do I need one?

    An ultrasound scan is an investigation which uses sound waves to form a picture. This is done by using applying a probe to the skin with some gel. It is quick, completely non-invasive and relatively inexpensive.

    I commonly use ultrasound for patients with shoulder problems as many of the important structures in the shoulder joint can be seen easily. The scan, usually done in addition to an X-ray, often gives me all the information I need to recommend appropriate treatment. Ultrasound scans have a more limited use in the knee, especially if the problem is located deeper within the joint as the structures are not well visualised on ultrasound.

    We currently have an excellent radiographer who performs scans at the Sports Centre on Wednesdays. On other days, the scans may be performed in the main radiology department on the ground floor.

    What is an MRI scan? Do I need one?

    An MRI (magnetic resonance imaging) is a scan made using a powerful magnet. It gives a detailed image of the body’s tissues  – where an X-ray shows mainly bone and a little bit of soft tissue, an MRI can distinguish bone, cartilage, tendons, ligaments, fat, nerves and blood vessels. It is safe and non-invasive (unless a contrast is given – this is a type of dye given by injection to highlight abnormal areas, and in orthopaedics the contrast is usually injected into the joint).

    Despite being an excellent imaging tool, MRI scans are expensive and for this reason are not obtained routinely. An MRI scan is usually requested to obtain a diagnosis when more basic investigations have not helped; or to plan for surgery.

    Many medical aids include one or two MRI scans a year as part of the radiology benefits. Even so, there may be a small co-payment. If you do not have a medical aid, you will have to pay for the scan in full. The radiology department can check these details and confirm your benefits – National Radiology Service (011) 304 6677.

     

    I need an MRI scan but my medical aid will only pay for it if I am admitted. Can you admit me for the scan?

    No. Please don’t ask.

    I believe this constitutes medical aid fraud and I will not admit you for the sole purpose of having an MRI scan.

    Do I need to see a physician before having a procedure?

    You may need to see a physician if you are having a joint replacement and/or if you have a significant medical condition. The reason for this is to ensure that you are fit to have the intended surgery. The physician may need to alter your medication to optimise your health so that your procedure may be performed safely. The physician may also be involved in your daily care after the operation and so I normally recommend that you see one of the specialists at the hospital where your operation will be performed, but if you would prefer to see your regular physician then this can also be arranged.

    What is the procedure for booking an operation?

    The first step is to establish the date of the surgery. You will then receive an e-mail with all the necessary information regarding your admission. The e-mail will contain the codes you need to obtain authorisation from your medical aid to be admitted to hospital for the procedure. This is easily done online, by telephone, or in person at the hospital reception desk. Please note that we do not offer this service, but are more than happy to help you if you are having difficulties.

    The e-mail will also contain:

    • Information on what time to be admitted
    • Information on when to stop eating and drinking
    • Information on other service providers that you may need to contact (e.g. the orthotist for crutches or a brace) before being admitted

     

    Where will my operation be performed?

    I operate mainly at Netcare Waterfall Hospital and Mediclinic Morningside. On occasion I do some procedures at Netcare Sunninghill Hospital. The choice of hospital depends mainly on the surgery you are having, but other factors such as the urgency of the procedure as well as your medical aid may dictate where the procedure has to be performed.

    All three facilities are of a high standard and are well equipped, and have competent nursing and rehabilitation staff.

    How long do I need to starve before surgery? Can I take my regular (chronic) medication?

    You should have nothing to eat for 6 hours before your operation. You may drink clear fluids (water, black tea/coffee (no milk), clear juice) up to 2 hours before the operation. It is often not easy to give you an exact time of when your operation will start. As a rule of thumb, if your procedure is in the morning, it is best not to eat anything after you go to bed the night before. If your procedure is in the afternoon, we will tell you to have a light breakfast before a specific time in the morning.

    You can have all your usual chronic medication in the morning with a sip of water except diabetic medication (including insulin) and/or blood thinning tablets.

    If you are unsure, please contact us.

    What is the procedure on the day of surgery?

    The most important thing is that you are starved. You should have nothing to eat for 6 hours before your operation. You may drink clear fluids (water, black tea/coffee, clear juice) up to 2 hours before the operation. You can have all your usual chronic medication in the morning except diabetic medication (including insulin) and/or blood thinning tablets. If you are unsure, please contact us.

    The second important thing is not to be late. You are normally asked to be admitted quite early in the morning to give you ample time to check in to the hospital, go to the ward, and be prepared by the ward staff. There will be many forms to complete and anaesthetist will also see you.

    When you come to the hospital, the first place you need to go to is the hospital reception desk. They will then direct you to the ward.

     

    What kind of anaesthetic will I have?

    There are different types of anaesthetics available and the choice of anaesthesia depends mainly on the procedure you are having as well as any medical problems you may have. For orthopaedic procedures we mainly use four types of anaesthetics:

    • General anaesthesia: You are “put to sleep” and need a tube or similar device in your throat to control your breathing
      • Shoulder arthroscopy, rotator cuff repairs, acromioplasty, Bankart repairs, calcium removal from rotator cuff
      • Knee arthroscopy, ACL reconstruction, meniscal repair/debridement, MPFL reconstruction
    • Spinal anaesthesia: You are given an injection in your lower back which makes your legs completely numb. Usually a light sedative is given as well
      • Total knee replacement
    • Regional block: You are given an injection around a large group of nerves to make an isolated area numb (for example your right arm). In my practice this is mainly used in conjunction with certain shoulder procedures for better pain control
      • Rotator cuff repairs, Bankart repairs, total shoulder replacement
    • Local anaesthesia: You are given an injection around a small group of nerves or into an area of skin to make a small area numb (for example an area on your wrist or hand, or a single finger). Usually a light sedative is given as well
      • Tennis elbow release, carpal tunnel release, trigger finger release, De Quervain’s release

    How long is an operation?

    Most orthopaedic procedures are usually no more than an hour or two. A simple arthroscopy may take as little as half an hour. However, when you add in the amount of time for the anaesthetic, positioning, and waking-up in the recovery area, the actual time away from the ward is a lot longer. Please tell your loved ones not to be alarmed if it seems that things have been taking longer than you expected.

    Do you use a surgical assistant?

    An assistant who is a qualified medical doctor may be used to help with the procedure. They are valuable members of the surgical team and can make extremely beneficial contributions to the success of your operation by assisting in both simple and complicated cases. In some instances where the procedure is complex, I may invite another orthopaedic surgeon to assist with the operation to help ensure that things run smoothly. Their fee is a small percentage of the procedure fee and is reflected by a specific code on your account in order for your medical aid to reimburse you according to your chosen plan.

    Will I need to go to high care or ICU after surgery?

    This depends on the nature of the procedure and your general health. For example if you are an older person undergoing a total knee replacement and have co-existing medical conditions like high blood pressure or diabetes, then you may need to spend one or more days in the intensive care unit after the operation so that we can monitor your condition more closely. For most arthroscopic procedures however, and especially if you have good general health, you will not need admission to high care.

    Will there be any pain after the procedure?

    One of our primary aims is to ensure you are as pain-free as possible after surgery. This is beneficial not only for your comfort, but also for your recovery and rehabilitation. You may receive a nerve block as part of the procedure which will numb the operative field. Your anaesthetist and I will also prescribe the necessary medication you need for optimum pain control, both in-hospital and for when you go home.

    What is the approximate length of time in hospital?

    The following procedures are day case procedures. This means that you will normally go home on the day of surgery and not stay overnight in the hospital:

    • Knee arthroscopy (meniscal repair/debridement, microfracture)
    • Shoulder arthroscopy (acromioplasty, calcium excision from rotator cuff)

    The following procedures usually require you to stay overnight in hospital and be discharged the next day:

    • Knee: ACL reconstruction, MPFL reconstruction
    • Shoulder: Rotator cuff repair, Bankart repair

    The following are bigger procedures where you will stay in hospital for two or three days:

    • Total knee replacement
    • Total shoulder replacement

    Do I need to see a physiotherapist after the surgery?

    Physiotherapists are an integral part of the success of your procedure. I am fortunate to maintain a close relationship with many physiotherapy practices, and especially with physiotherapists in practices with further qualifications and experience in sports rehabilitation.

    After surgery, and while still in hospital, most patients will need to see a physiotherapist before going home. This is to ensure that you are able to get around safely at home, especially if you are in a brace and/or need crutches or other walking aid. In most cases you will see one of our highly competent physiotherapists from the practice in the Sports Centre. Not only are they qualified and experienced sports physiotherapists, they also specialize in a broad range of non sports-related rehabilitation.

    After you have been discharged, if you are not able to continue with our in-hospital team, I prefer to refer you to a trusted practice who is located near to where you live or work for convenience.

    When do I see you again after being discharged?

    In most cases I will ask to to see me for a follow-up appointment 10 days after surgery. The main purpose of this visit is to check your wounds to make sure they have healed. It is important that you do not miss out this appointment. If you have a splint or cast, this may need to be removed or changed for a new cast at this time.

    For children who have been treated for a fracture, I will usually request an earlier follow-up for a check X-ray, usually 7 days or earlier.

    If there is any uncertainty about your appointment, please call Monique Kotzee on 011 304 6784 to confirm.

    What do I do about my dressings? Can I get them wet?

    In most cases, you do not need to remove your dressings (plasters). If you have had a knee arthroscopy, I usually cover the plasters by wrapping the knee in wool and crepe bandage. You may remove this 48 hours after the surgery, but do not remove the sticky plasters. If you have had a shoulder arthroscopy I usually just apply the sticky plasters.

    Please keep the operated knee or shoulder dry. Do not submerge your knee or shoulder in water. If your wounds get wet, this may result in an infection. The sticky plasters I use are called Opsite plasters and they are in fact waterproof, but despite this water can still get into the wound if you are not careful.

     

     

    There is blood and/or fluid leaking from the dressing – should I worry?

    During a shoulder or knee arthroscopy, fluid is pumped into the joint to expand it so that I am able to see and work inside. At the end of the procedure, as much of this fluid is drained as possible. Despite this, some of this fluid will remain in the joint and can leak through your wounds over the next 48 hours. Sometimes a small amount of blood may stain the plasters and cause concern.

    If the fluid leak is not excessive do not be concerned, this should dry up in a day or two. The same applies for a small amount of staining of the plaster with blood. The plasters do not need to be changed, but you may apply a new Opsite plaster after 48 hours if the original ones look unsightly.

    *** If a fluid leak persists for several days, or if there is bleeding which leaks out the plaster and continues to bleed despite elevation and pressure, please contact me immediately ***

    How soon can I drive after an operation?

    It is recommended that someone drive you home after surgery and you will certainly not be allowed to drive a car if you have had a procedure the same day. The timing of resumption of driving after your operation can be difficult to establish and should be individualised to each patient, bearing in mind that according to insurance companies and law enforcement agencies, the patient is ultimately responsible for the decision to drive. A general rule of thumb is not to drive if you would require some form of analgesia to do so. Safe driving is usually possible with a simple forearm cast, but an elbow splint or an arm sling can significantly hamper your ability to drive safely. After a shoulder arthroscopy or an acromioplasty, you should be safe to drive by two weeks or earlier, but it may take four weeks after a rotator cuff repair. You should also be able to brake safely and normal braking function after a right knee arthroscopy takes about four weeks, and about six weeks in ACL reconstruction and driving should be avoided with a cast or brace on the right leg. After a left ACL reconstruction, you may be able to drive after two weeks. For a total knee replacement you could drive at about four to six weeks.

    For more information, please refer to the following useful article from the Journal of the American Academy of Orthopaedic Surgeons: Driving after Orthopaedic Surgery

    How soon can I get back to work after the operation?

    This depends on what sort of work you do. If it is mainly a desk-job then you could be back at work within a few days. If your work involves more activity then the amount of time you will need to be booked off for will have to be individualised according to the procedure you have had, your weight-bearing status, the need for crutches and braces etc. I will provide you with an appropriate medical certificate and, with your permission, would be happy to discuss the situation with your employer if this is necessary.

    Do you treat back conditions?

    Unfortunately not. Surgery of the back and neck is highly specialised and if you need an operation it should be performed by a surgeon with the appropriate training and experience in this field and who can also understand and interpret potentially costly investigations that may be needed in obtaining an accurate diagnosis. My orthopaedic interests and training have helped me focus on conditions of the knee and shoulder, and I recommend that your GP refers you either to an orthopaedic surgeon who regularly treats back problems or to an appropriate neurosurgeon.

    Email: admin@drmatthee.com | Phone: 011 304 6784 | | |

    © Copyright 2015. All Rights Reserved Dr Warren Matthee
    %d bloggers like this: