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Should an internist evaluate each patient before ambulatory surgery?
The same rules and standards regarding a complete pre-operative evaluation of patients apply to surgery scheduled on either an inpatient or an ambulatory basis. Accordingly, an internist or medical subspecialist should be consulted regarding the advisability of surgery at a particular moment in time whenever the stability of a patient’s medical condi-tion is questionable. Although it may be true that the resultant physiologic perturbations associated with some ambulatory surgery procedures may be characterized as minor, there is nothing minor about the administration of an anesthetic. A complete written history and physical examination are required as part of the medical record before the administration of anesthesia and commence-ment of surgery. For patients with no or stable co-existing medical conditions, the complete history and physical can be done by the surgeon. However, for patients with significant co-existing medical diseases and/or whose medical status may be questionable, there should be an evaluation com-pleted by the internist or medical subspecialist.
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