To the Editor.
—After seeing how many preoperative consults by internists are ignored, Klein et al, in their article published in the April Archives (1983;143:743-744), concluded that follow-up was necessary. Perhaps the problem of unrequited consults is the lack of knowledge of internists about what physiologic and pharmacologic changes occur in the perioperative setting and what characteristics determine perioperative morbidity. As an anesthesiologist-internist who is called on both to do and judge consults, I am often saddened that the knowledge an internist has about the patient is not conveyed in the consult."Don't let the patient become hypoxic or hypotensive" has been replaced as a closing line in the typical medical consult as internists too have realized that vasodilation may be good for the heart. Now "cleared for surgery" fills many closing lines. What does that mean? Nothing in particular to the anesthetist or surgeon who is trying to keep