But, things being what they are, she came with the handout that she was sent, and I set about trying to figure out who, exactly, wanted these exams. This episode I entitle, therefore
Adventures in unneeded pre-op for cataract surgery
1. The surgeon says the anesthetist wants it
2. The anesthetist says the administrator requires it
3. The administrator says the board "considered [getting rid of preop tests for cataract removal]" 2 years ago but was concerned how it would look to other hospitals in the area
And she told me to talk to the medical director.
I reached the medical director. He said, "You're right. And I'm so frustrated! They [!] are tying my hands."
"But didn't you ---?"
"The board decided it. There are so many more requirements these days. You know that Medicare won't pay if there's a new infection."
"But that's different. That's evidence based."
"Medicare requires [these preop tests] for cataract surgery."
"They do? I don't think that's true. And don't you know about the Choosing Wisely recommendations [not to do such preop tests]?"
"I do. But In any case," he continued -- dogs barked in the background ("I'm working from home") -- "we can't change policies since it's the norm now."
I told the patient about all this. "I can understand if you choose to go with your previously scheduled surgery, and I would order the tests if you wanted to keep it."
She chose to get re-evaluated at our ophthalmology center. For all of Hopkins's imperfections, Wilmer is doing a great job of moving towards fewer contraindicated preop tests.
A partially happy ending! And that medical director DID say, "Your phone calls have put this issue on the radar."
* * *
Before you start smiling and drawing rainbows and unicorns, though, I'll tell you about a patient I saw that same day, who came to be "pre-opped" not for cataract removal but for (low-risk) plastic surgery. She told me, "Your secretary already checked with [the surgeon's] office, and they said they wouldn't touch me without these tests."
So I ordered them, because the patient wanted them.
Net win? Net loss? Somewhere in between?
Or just another up-and-down day, trying to move the blip in a system which is resistant to change and still, endemically, prone to overuse because "someone" thinks these tests are necessary.