Correspondence  |   January 1997
Anesthesia Preoperative Evaluation Clinic: IV
Author Notes
  • Clinical Instructor, Department of Anesthesiology, Baylor College of Medicine, 6550 Fannin, Houston, Texas 77030.
Article Information
Correspondence   |   January 1997
Anesthesia Preoperative Evaluation Clinic: IV
Anesthesiology 1 1997, Vol.86, 261. doi:
Anesthesiology 1 1997, Vol.86, 261. doi:
To the Editor:-In a recent issue of Anesthesiology, Deutschman and Traber [1] addressed the future of our specialty and Fischer [2] described creation of an Anesthesia Preoperative Evaluation Clinic. I applaud the concept of making ourselves more visible and wish to share my vision of extending the scope of our specialty.
There are two components to my plan. The first is that anesthesiology become a primary admitting service for a limited number of diagnoses. I believe foreign bodies in the airway, smoke and carbon monoxide inhalation, poisoning, drowning, and cardiac and hypovolemic shock are just a few of the diagnoses for which we are capable of taking primary responsibility. As this new idea of therapeutic anesthesiology develops and is refined, it may even find us in the operating room as proceduralists (apart from pain management).
The second component entails the creating of a primary admitting service (anesthesiology acute care) for procedural/subspecialty care in hospitals. Currently, many of our colleagues in orthopedics, oral surgery, gynecology, ophthalmology, radiology, and plastic surgery-just to name a few-admit patients for subspecialty care and procedures. In the climate of cost containment and restrictive covenants, they alone (without the luxury of consultation to internal medicine or subspecialties) must deal with areas of patient care for which they may have little interest or knowledge. What I propose is that we become the admitting service for these services (in some respects, this proposal is similar to that recently proposed by Wachter and Goldman [3] -albeit for internists-to develop a cadre of physicians called hospitalists). Each patient would be cared for by anesthesiology, with their subspecialist/proceduralist becoming a consultant. This arrangement has several benefits for all involved. First, this will permit the internists to concentrate on primary outpatient care. Second, the orthopedist, ophthalmologist, etc., need only focus on their area of practice; anesthesiology would manage the patient's secondary diagnoses (chronic obstructive pulmonary disease, asthma, diabetes, hypovolemia, angina, hypertension, etc.). Third, each patient would be prepared by the anesthesiologist for the operating room, permitting greater operating room utilization and continuity of care. With the aging patient population, it becomes even more pressing that patients be meticulously prepared for the operating room and have smooth, seamless care in the postoperative phase.
These are not short-term goals. They will take planning, research, training, and a gradual, but profound, shift in attitude. I believe the crux of change will begin with our residency directors. Physicians usually practice what they are taught and, if these new aspects of therapeutic anesthesiology and acute care are to be implemented, it is in our training programs that we must begin.
Richard Silverman, M.D., Clinical Instructor, Department of Anesthesiology, Baylor College of Medicine, 6550 Fannin, Houston, Texas 77030.
(Accepted for publication October 10, 1996.)
Deutschman CS, Traber KB: Evolution of anesthesiology. Anesthesiology 1996; 85:1-3.
Fischer SP: Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology 1996; 85:196-206.
Wachter RM, Goldman L: The emerging role of “hospitalists” in the American health care system. N Engl J Med 1996; 335:514-7.