Do you know what my first exposure to the concept and question of “is this patient of an acceptable risk to proceed to the OR?” Was?
Want to take a guess?
It was a lightbulb moment for me as an IM resident!
Periop wasn’t just cardiac…
For starters, 12% of the ABIM board exam is perioperative and consultative medicine, yet there’s no standard curriculum in this
✳️Many are becoming Hospitalists
✳️PCPs have a role in periop medicine
✳️Any medicine sub specialty (not just cardiology) might be asked periop questions
(Ex. From @OHSUIMRes)
This is from a survey I did of @OHSUIMRes residents several years ago
But WHY is this a necessary AND such a fantastic learning opportunity? What can you teach via time in preop clinic?
⏺Is that murmur in the X pathologic? Could it be severe AS?
⏺Is that atypical chest pain in a 25yo athlete concerning for CAD? In a 80yo woman with DM?
How do we counsel patients re risk when we’re not sure if they will be the X% of patients who might have a complication?
Granted, you’re seeing the small N% of patients actually need surgery, but…
Teach a budding PCP how cervical myelopathy, prosthetic joint infections, ovarian cancer might present
ACGME once used 6 core-competencies
though we moved to EPAs, I still find these valuable for #periop goals:
However, as excited as I get about the “medicine” of #periopmedicine, it’s everything else that I’m really excited to teach in preop clinic
whereas I might want a student to hear me talk to a surgeon about cancellation/postponement…I might want a resident to take the reigns on that conversation herself
How do I get my patient who lives 8 hours from Portland a stress test before their surgery when they live in a care dessert and don’t have the gas money to drive back to Portland??
You want your learner to see enough of a “random” assortment of both surgical pathology and medical comorbidities
What are my “I want you to have experienced/worked through this”??
🌀See (and feel) “stable and optimized”
🌀See the clearly unstable/not appropriate for surgery at this time
🌀the “grey zone”—the diagnostic dilemma:
🌀🌀MACE > 1%
🌀🌀Stress for atypical symptoms
🌀🌀ECHO for difficult to assess murmur or volume status