Surgical Clearance for a Hernia Repair?

[Foster]

Hi Dr. Steve,

about three weeks ago I developed a hernia in my lower abdominal area.
never had one before, so I freaked out a little and went to the ER when I first noticed it, it isn't very painful.
the doctor at the ER was kind of nonchalant about the whole thing, said it wasn't an emergency, but the only way to fix it was surgery. He then said that I should go see my regular doctor asap.
went to my regular doctor a few days later, he examined me and basically said the same thing and gave me a name of a surgeon, if I want to have it repaired. (by the way, both of the doctors gave the "if gets worse or painful go to the ER" talk)
I decided to have it repaired now, before it got any worse, and also before the weather got nice, so I went to see the surgeon.
He examined me, scheduled a date for the procedure, and also an appointed to have a pre-surgical work up done beforehand.
I just got back from the pre-surgical exam and with the exception of the hernia, I'm in excellent health.

NOW they tell me I have to go see my regular doctor again for surgical clearance!
Since I was just there a few weeks ago, for the same reason, I thought maybe they could just call the surgeon and give him the OK.
But NO! I have to go in and see him again, before he can give the OK.

I ask you, isn't this a waste of resources, money and time.
I'm 41 years old, no history of illness, and I'm in good shape.
why is there a need to have four different doctors give me the same exam over and over?

thanks,
foster

[Dr Steve]

Hi Dr. Steve,

about three weeks ago I developed a hernia in my lower abdominal area.
never had one before, so I freaked out a little and went to the ER when I first noticed it, it isn't very painful.
the doctor at the ER was kind of nonchalant about the whole thing, said it wasn't an emergency, but the only way to fix it was surgery. He then said that I should go see my regular doctor asap.
went to my regular doctor a few days later, he examined me and basically said the same thing and gave me a name of a surgeon, if I want to have it repaired. (by the way, both of the doctors gave the "if gets worse or painful go to the ER" talk)
I decided to have it repaired now, before it got any worse, and also before the weather got nice, so I went to see the surgeon.
He examined me, scheduled a date for the procedure, and also an appointed to have a pre-surgical work up done beforehand.
I just got back from the pre-surgical exam and with the exception of the hernia, I'm in excellent health.

NOW they tell me I have to go see my regular doctor again for surgical clearance!
Since I was just there a few weeks ago, for the same reason, I thought maybe they could just call the surgeon and give him the OK.
But NO! I have to go in and see him again, before he can give the OK.

I ask you, isn't this a waste of resources, money and time.
I'm 41 years old, no history of illness, and I'm in good shape.
why is there a need to have four different doctors give me the same exam over and over?

thanks,
foster

first: good luck with the hernia repair. it's called a "herniorrhaphy" and generally goes well. Hernias are no big deal UNTIL they twist and strangulate and then all of a sudden they become a life threatening emergency so I don't disagree with having it fixed prophylactically.

Now, about the surgical clearance. The answer is, it depends. If you're at high risk for cardiac disease (diabetes, high blood pressure, high cholesterol, etc), your primary doc may not have given the surgeon enough information to make the anesthesiologist feel comfortable about putting you under. However, most of the time, this is just a "cover your ass" kind of thing, where the surgeon sends you to an internist or family doc for "surgical clearance" so if anything happens during surgery the surgeon can point at the primary care doc and say "Well, HE TOLD ME THIS GUY WAS OK".

Honestly, it's a load of crap, for the most part. You can calculate your risk by using one or more of these calculators:

http://www.surgicalaudit.com/riskcalc.asp

http://www.vasgbi.com/riskdetsky.htm

Don't necessarily blame your primary care doc...he/she may be wondering why the surgeon is so insistent on getting surgical clearance and wants to see you to make sure they didn't miss something. And the surgeon wants to cover his ass because he doesn't know you from Adam and he's trying to reduce his risk of liability. All of this is what we call "defensive medicine" and runs up medical costs because doctors are terrified of being sued.

Anyway, good luck with the surgery and let us know what transpires.


your pal,


steve