Dr Pho at KevinMD gives his take on the recent research suggesting preoperative evaluations result in billions of dollars a year in unnecessary testing. To investigate, Wright and his colleagues reviewed medical records for women who underwent gynecologic surgery at their center between 2005 and 2007. They found that 95 percent of the 1,402 patients received all the recommended testing, but 90 percent had at least one test that was not necessary based on guidelines from the National Institute of Clinical Excellence (NICE).
The most common reason cited was medicolegal. Doctors don't want to get sued for not having a test done before surgery. How about preoperative evaluations in the hospital? Here's my take as a hospitalist. I am often asked to do preoperative evaluations on two classes of patients. The first are patients who couldn't get in to see their primary care physician and need a "preoperative evaluation" two hours before their elective non urgent outpatient same day discharge ophthalmology or orthopaedic surgery. The second are patients who require non elective surgery on an urgent or emergent basis.
The most common reason cited was medicolegal. Doctors don't want to get sued for not having a test done before surgery. How about preoperative evaluations in the hospital? Here's my take as a hospitalist. I am often asked to do preoperative evaluations on two classes of patients. The first are patients who couldn't get in to see their primary care physician and need a "preoperative evaluation" two hours before their elective non urgent outpatient same day discharge ophthalmology or orthopaedic surgery. The second are patients who require non elective surgery on an urgent or emergent basis.
Most hospitals require any patient going into surgery to have a history and physical examination documented in the patient's chart before they enter the operating room. Surgeons are capable of meeting this requirement by the nature of their extensive training. Hospitalist training does not provide any additional experience for completing this basic requirement that would prevent a surgeon from completing this remedial task without assistance. However, if the question of further preoperative evaluation is the question being asked, hospitalists are qualified to render their opinion on that matter.
