The Pre-Operative Physical Exam

In Preparation for Your
Surgery or Other Medical Procedure

The Problem

Patients are upset when their pre-operative physical results in a delay of their surgery.

Background

The purpose of a pre-operative physical exam is to determine whether it is safe for the patient to undergo surgery.

Surgery is dangerous. It is important for the patient to be at an optimum level of health before undergoing surgery.

Quite often a problem is discovered during the pre-operative physical that results in a delay in the surgery.

Examples of such problems are:

• Abnormal EKG On patients over a certain age, an EKG is performed during any pre-operative evaluation. What happens if the EKG is abnormal? In that case, the patient has to undergo a stress test to make sure that the patient does not have heart disease. This usually results in a delay of the surgery because the stress test has to be scheduled with the cardiologist.
• Chest Pain During a pre-operative physical, the doctor will ask the patient whether he has had chest pain. If the answer is yes, and if it isn't obvious what the cause of the chest pain is, the doctor will most likely order a stress test to make sure that the patient does not have heart disease. This may result in a delay in the surgery, for the stress test to be scheduled.
• Laboratory Abnormalities During all pre-operative evaluations, blood tests are ordered. If one of the tests is abnormal, the surgery will have to be delayed for the cause of the laboratory abnormality to be determined.
• High Blood Pressure If the patient's blood pressure is mildly elevated, it's not likely to delay the surgery. But if the blood pressure is moderately or severely elevated, then the blood pressure will have to be normalized before the surgery. This could take several weeks or even longer, while the patient's blood pressure medications are adjusted.
• Uncontrolled Diabetes Patients whose blood sugars are not well controlled should not have elective surgery. Thus, if a diabetic patient comes to the doctor for a pre-operative exam, and his/her blood sugar is very high (e.g. over 300), the doctor will most likely postpone the surgery until the diabetes is under better control.

Why are patients upset by unexpected delays in surgery?

If your cataract has been interfering with your ability to see, and you now are scheduled to have the cataract repaired next week, it's very upsetting to be told that your cataract operation will need to be delayed.

So it's not surprising that patients are upset when their surgeries are delayed.

Why do patients blame the doctor?

What blows my mind is that most patients whose surgeries are delayed get angry at the doctor!

Some reasons for inappropriate blame being directed at the doctor come to mind:

• The surgeon creates an unreasonable expectation in the mind of the patient that the pre-operative exam is just a formality. In point of fact, it isn't.
• The patient has been ignoring aspects of his health care, and is upset to have to start taking care of himself. He'd rather blame the doctor than himself when the reason for the delay in his surgery is actually the fact that he hasn't been taking his blood pressure medicines, or keeping follow-up appointments with his doctor for his diabetes.
• She can't afford the cost of additional testing. The patient might not have insurance, has managed to scrape together enough money for the cataract operation, but can't afford the stress test that will now have to be done. Since she doesn't have chest pain, she thinks that the only reason she's having to get the stress test done is because this busybody doctor just wants to cause trouble.

Over 50% of pre-op exams result in delays in surgery.

So be prepared for the possibility of a delay. And please don't blame the doctor if the surgery has to be delayed. The doctor only wants to ensure the safest possible surgery for the patient.

The doctor who places the patient's convenience ahead of the patient's safety is a poor doctor.