Historically, it has been the operating Surgeon’s responsibility to assess the patient not only for the body part or organ the Surgeon would be operating on, but also patient as a whole. If during such an examination, with the knowledge, expertise and the experience of the Surgeon the patient was found to have a medical issue that could complicate the surgery and perioperative care beyond the Surgeon’s expertise, then naturally the Surgeon was obligated to refer the patient to the appropriate specialist(in the field of the abnormality detected) and get an opinion from the said specialist. Upon receiving the opinion, together with the Surgeons own training and experience it would be the Surgeon who would make the decision regarding fitness for surgery. It would be the Surgeon who will determine the risks, potential risks and advise the patient. The ultimate decision from the medical personnel team would be the Anesthesiologist.
Over the last several years what has happened is that many Surgeons have been asking primary care Doctor’s for the so-called surgical clearance. Most primary care physician’s are not specialists,they are not the ones who would be doing the surgery, they would not know all the risks that would entail with the surgery . They would not be familiar with potential perioperative risks necessarily. Yet, the operating Surgeons have outsourced the responsibility to the primary care Doctor’s. Indeed to make matters more complicated the primary care Doctor is being asked to stratify the risk without knowing the intricacies of the surgery and certainly not having the experience of knowing what all that may be involved in the operation. Indeed , recent training and practices have limited the exposure of the primary care Physicians of such procedures in training and in practice by not allowing them in the operating rooms.
This blanket request by the operating Surgeon adds not only extra expense and expenditure of time on the part of the patient but also risk(s).
Medicare guidelines have not addressed this issue in a satisfactory detail. I’m assuming commercial insurance industry will not take a position.
I have struggled with this by initially by not participating in doing these clearances. But, I came to realize that patients perceived my refusal to participate in these clearances as an obstructionist in the process of receiving better health including alleviation of pain.
After discussing with a general Surgeon who is now retired ,I have modified my position.. It was pointed out to me that while my position has strong merits, the practice of Medicine has long ago moved to an arena where it has now become the norm where many Surgeons do not assess the patient.I feel that these Surgeons have become mere technicians.
It was pointed out that with the training of newer Surgeons and those who do not assess their own patients, and their experience, or the lack of it , regarding assessment,more than likely I would be able to do a much better examination of the patient . My assessment would serve patients better.With this in mind ,I wish to let you know that I shall do the surgical clearance examination to the best of my ability. This is also to inform you that there are many surgeons out there who do not practice medicine in this fashion of outsourcing preoperative assessment. You may choose to seek care from such responsible Surgeons.A more robust preoperative assessment by Anesthesia may be complementary .
Please be informed also that Medicare may not cover this assessment and you may be responsible for paying out of pocket for the said “clearance”. With commercial insurance you’re urged to contact your insurance company and request coverage information.