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Preoperative Evaluation/Patient Issues/History & physical before surgery

Question:

The ambulatory surgery center my group covers has a policy that all surgical patients have a current history and physical prior to their procedure. Some of the podiatrists at the center have requested that the histories and physicals on their patients be performed by the anesthesiologists rather than sending them to a primary care doc. Would we be offering a valuable and convenient service to these patients or opening Pandora's Box in terms of added medical legal liability?

-- From John Martucci, M.D., Downer's Grove, IL

Reply:

Yes.

Question:

The big question is why would you want to do this? A surgical H&P has to include a description of the surgical site and indications for surgery. As an anesthesiologist I'm not interested in writing that note! I'm not sure that you can get paid for both this note and not have it be part of the Pre-Op note that you need to write. Lastly, if you start acting as the primary care doc on this, you assume responsibility for following up on any abnormalities identified.

Why not get a brief note from the patient's PCP- even a recent clinic not would suffice. The facility may be able to declare that the note from the anesthesiologist qualifies as an H&P as well as the pre-anesthesia note, but I would still be careful that this declaration does not attach an unwanted duty to follow-up on the patient.

-- From Alan P. Marco, M.D., M.M.M., Toledo, Ohio

Reply:

There may be significant conflict of interest/legal issues with Medicare in that one cannot supervise an anesthetic/ perform an anesthetic as well as perform the Primary History and Physical. I was in private practice briefly approx one year ago. The Medicare laws were reasons cited to stop performing the preoperative H&P as well as the anesthetic. Our podiatric colleagues will just have to send their patients for H&Ps to the primary physician or the ASC will have to have another individual available that will not have anesthetic duties as the primary concern.

-- From Andrew Herlich, D.M.D., M.D., Philadelphia, PA

Reply:

In Michigan, we performed the H&Ps as a service to our non-physician colleagues and their patients. One does have to dust off the old physical diagnosis skills from med school and internship, but it's like riding a bike. Do make sure that you bill for the service.

-- From Thomas W. Cutter, M.D., M.A.Ed., Chicago , IL

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