Patients who claim they are in good physical shape

[Temeraire]

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Can I just point out something I’ve observed during my short time as a resident: You know those patients who seem to ace the 4 METS question by saying they can take the stairs without issues or “walk 2 miles every day,” and then when you ask them to scooch up towards the head of bed, they huff and puff and nearly pass out from that minimal amount of physical exertion — ok whatever.

 

[deleted875186]

The METs questions are terrible. I sometimes ask people what they do around he house, because everyone says they can walk up two flights of stairs. Maybe they think the small 3 step walkway up to their house counts as one flight.

 

[IMGASMD]

Can you cook? Can you walk around your house? Do you do gardening in the spring? I consider those are pretty good questions. Not exact 4 Mets, but if they can do their daily activities without too much difficulty, we can probably proceed.

 

[NITRAS]

I don’t remember the last time someone told me they walk up stairs. . . They don’t exist. The stairs evaporate at 65 yo.

 

[Psai]

I can't judge since I'm barely pushing 6 mets as it is.

 

[deleted697535]

A colleague of mine described himself as reasonably fit to me recently prior to going for elective surgery

He definitely is not. I'd probably cancel him. He takes the elevator to code tramuas!! And that's only 2 floors!! Down!

If staff anesthesiologists are so far off on their own eval I can see why the public are too

 

[Psai]

A colleague of mine described himself as reasonably fit to me recently prior to going for elective surgery

He definitely is not. I'd probably cancel him. He takes the elevator to code tramuas!! And that's only 2 floors!! Down!

If staff anesthesiologists are so far off on their own eval I can see why the public are too

I like going up stairs but going down is bad for your knees and back imo.

 

[CopaceticOne]

The internists at my place sometimes use the Duke Activity Status Index. I think it overestimates METS, but the questions are actually pretty good.

Duke Activity Status Index (DASI) - MDCalc

 

[d9sccr]

The internists at my place sometimes use the Duke Activity Status Index. I think it overestimates METS, but the questions are actually pretty good.

Duke Activity Status Index (DASI) - MDCalc

I don't have access, but this article seems to jive with what they do as well as what's being mentioned in this thread

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31131-0/fulltext

 

[Guillemot]

4-6 METS is just for perioperative risk of MACE. Don't kid yourself and think that means youre in good shape if you are able to climb 2 flights of stairs. A young obese person with diabetes and HTN can pull that, but they will probably die relatively young.

 

[midazzoler]

As a resident the elevator went out at the local VA once. Everyone had to use the stairs. Got stuck on a landing while patients and family were going up and taking up the whole width of the stairway. If looked hard enough I could see the lactic acid being created in their legs and hear the ST elevation in their respirations. It was really neat. As a wanna be amateur athlete I know what its like to get "pumped" quickly and not be able to use extremities very well. I can't imagine getting that feeling from walking up one flight of stairs.

 

[Planktonmd]

A colleague of mine described himself as reasonably fit to me recently prior to going for elective surgery

He definitely is not. I'd probably cancel him. He takes the elevator to code tramuas!! And that's only 2 floors!! Down!

If staff anesthesiologists are so far off on their own eval I can see why the public are too

Elevators are there so you don't have to take the stairs so quit your masochistic self flagellation!

 

[NITRAS]

I don't have access, but this article seems to jive with what they do as well as what's being mentioned in this thread

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31131-0/fulltext

ACC has a free app, I think Guideline Clinical Apps that has it (as well as a LOT of other stuff). Its kind of busy, but look in the periop section.