Pre-op evaluations

[2ndyear]

While doing my rotations this intern year, it seems like on my int med, cardiology, and pulmonary months the attendings are frequently consulted to do in house pre-op evaluations. Obviously it's usually fairly specific to the pathology, ie patient with prior CABG now needs a chole- consult cards; bad COPDer needs anything in the OR, consult pulmonary.

Now I'm not saying that these medicine docs and specialists aren't qualified to do these consults, they are. But isn't the anesthesiologist equally qualified to evaluate patients like this? After all, they are the ones who will be dealing with those problems intraoperatively. They are more familiar with the current surgical techniques as well.

Is this just specific to my cushy private intern hospital where the gas docs are a very private practice, no residents at all, and more than content to stay in the OR only?

I'm not sure I would want to spend half my day seeing old and sick people on the floor either, but this specialty is all about being a peri-operative physician right?

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[UTSouthwestern]

While doing my rotations this intern year, it seems like on my int med, cardiology, and pulmonary months the attendings are frequently consulted to do in house pre-op evaluations. Obviously it's usually fairly specific to the pathology, ie patient with prior CABG now needs a chole- consult cards; bad COPDer needs anything in the OR, consult pulmonary.

Now I'm not saying that these medicine docs and specialists aren't qualified to do these consults, they are. But isn't the anesthesiologist equally qualified to evaluate patients like this? After all, they are the ones who will be dealing with those problems intraoperatively. They are more familiar with the current surgical techniques as well.

Is this just specific to my cushy private intern hospital where the gas docs are a very private practice, no residents at all, and more than content to stay in the OR only?

I'm not sure I would want to spend half my day seeing old and sick people on the floor either, but this specialty is all about being a peri-operative physician right?

A variety of factors are involved in this situation. The anesthesiologist can do the evaluation for most any condition, but if a diagnostic procedure is thought to be necessary, it is sometimes required that the subspecialist of interest be involved in the evaluation of the patient for the sake of expediency.

I would feel very comfortable in knowing what type of and when to order a cardiac evaluation and even in reading perfusion and stress studies. However, that may not be the most feasible option especially if the patient is not in house.

Some surgeons and anesthesiologists have an arrangement for referral of patients for outpatient evaluation of patients, which can be performed days or weeks in advance of the proposed surgery.

Regardless, you must still review the information that is accumulated and you will have to discriminate to obtain the useful pieces of information that has been collected. You in essence will perform your own consultation just prior to surgery to evaluate the patient and to determine whether or not you agree with the outpatient/inpatient preop. I have had at least a couple of cases where a cardiologist cleared a patient for surgery that I then cancelled based on my history eliciting a change in what had been deemed chronic stable angina. One of them had an MI two hours later in his room.

You should develop your consultation skills as best as possible while you are on your subspecialty rotations and learn to trust your intuition once you have developed those skills. The postoperative setting will provide you with the final determination of the veracity of subspecialist's evaluation and your own evaluation.