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An Anesthesiologist's Philosophy on 'Medical Clearance' for Surgical Patients

Jay J. Choi, MD
Arch Intern Med. 1987;147(12):2090-2092. doi:10.1001/archinte.1987.00370120026007.
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The preoperative medical consultation provides an opportunity for the internist or medical subspecialist to contribute to a better surgical outcome for the patient. Medical review is requested to be sure that nothing related to the patient's present status, which might affect the outcome of anesthesia and surgery, is missed. Unfortunately, I have seen preoperative medical consultations that contained statements that were unnecessary and offensive, and could even put the anesthesiologist in a medicolegally awkward position. As a practicing anesthesiologist, I believe that these consultations could be made more useful if internists understood the point of view of the anesthesiologist. Here I wish to share my philosophy on medical consultation with medical consultants in order to help streamline their thoughts.

The following are statements commonly seen in preoperative medical consultations, and reasons why the statements may be objectionable to an anesthesiologist:

"No absolute contraindication to general anesthesia." It is the


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