Pre-op Clinic

Pre-op clinic, a requirement for all anesthesiology residents, is a strange and fascinating creature. We don't particularly like it, since most of us went into anesthesia to avoid clinic. And at first, it seems exceedingly easy. The vast majority of patients, having gone through the surgeon's office, are appropriate candidates for getting anesthesia and surgery. The pre-op visit assures that nothing is missed, that the patient receives all their instructions and education, and that labs and studies are reviewed. Practically, it means that 90% of the visits are very routine, and for anesthesiology residents, it can be a little tedious.

However, having done it every year of my residency, I've noticed that it's changed over time. As an intern, I was quite apprehensive about everything; I ran all my patients in detail by my attending, and I learned a lot. Gradually, I've done a week or two of pre-op clinic each year, and now at the end of residency, I feel quite independent. Perhaps I'll give my attending a one-liner for complex patients, but for the most part, I operate autonomously. Having done anesthesia for pretty much every surgery, I can tell a patient exactly what to expect; some need epidurals, double lumen tubes, arterial lines, blood transfusions, or avoidance of general anesthesia.

I also appreciate the nuances much more now. What happens when a patient has severe multiple sclerosis? Myasthenia gravis? End stage COPD? Fresh cardiac stents? Instead of defaulting on my attending's judgment, I now have a good sense of what I'd do as the anesthesiologist and can formulate a reasonable plan. Although clinic is not my favorite activity, at least I have a better grasp of its finer points.