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Wednesday, December 11, 2013
Can I see an anesthesia provider pre-surgery?
2008 is going to be a year that I will be having my first experience with having surgery and I will be having 3 operations and one "procedure" that might involve anesthesia. 2 knee scopes and a colonoscopy (which I can`t seem to get out of, no matter how hard I try). I have heard that a patient usually meets the anesthesia provider just before surgery; my doc says that she wants me to schedule these surgery/procedures (all outpatient) as soon as possible, but that all will likely involve some anesthesia (which I am scared to death of). My question is: since I know exactly the procedures are going to be, would it be possible to schedule an office visit with an anesthesia provider beforehand to discuss my options? I`m afraid that if I don`t do this, I won`t ever schedule the procedurs. My doc tried to briefly explain the anesthesia part, but said that it wasn`t really her area of expertise. I would gladly pay for the office visit out of pocket if needed; I called the local hospital`s same-day surgery department and they told me that I would be seen on the day of surgery-and that was it. Do anesthesia providers ever see patients in advance of surgery as outpatients? I called the anesthesia department and they told me that unless I was a "pain clinic" patient, that there was no way to see an anesthesia person beforehand. Is this correct?. Thanks.
Gee, that's not exactly customer service, is it? The answer to your question is yes, anesthesia providers do see their patients beforehand. Amazingly however, this is generally the exception rather than the rule in the United States, and many other places.
Interestingly, in France, considered one of the best national health systems in the world, a preoperative visit with an anesthesiologist is mandatory. But there are alternatives to flying over to Paris for your medical procedures.
In my hospital in Cleveland we, that is the Department of Anesthesiology, run an outpatient preoperative clinic in which we see about a quarter of all the patients scheduled for surgery. It's primarily for the sickest patients having the biggest operations but we do make special provision for the "worried well," which is perhaps the category you fit into. In other words anyone who wants to talk to us can make an appointment.
In the US, most academic medical centers have a clinic of this sort. They are expensive to run, but academic hospitals have residents which reduces the cost of delivering service. Also the hospitals tends to subsidize these clinics because they help the operating rooms to be more efficient.
Smaller hospitals, and outpatient surgery centers usually have some form of "preadmission" clinic or service, generally run by a nurse, and this sometimes is the point of contact between the anesthesiologists and their patients, with the nurse acting as a go-between.
You have every right to meet with your anesthesiologist, or a representative, to put your fears at rest. If your local center won't oblige, you do have some options. You could ask your surgeon to intervene on your behalf. Surgery centers usually like to keep their surgeons happy - they are the ones that bring in the business. You could write a letter explaining your request because sometimes you have to get around the people who answer the phone and block your request. Address that letter to the manager of the surgery center and/or the chief of the anesthesiology department.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University