The medical consultation

The physician is part of a team (including the surgeon, anaesthetist, nurse, and physiotherapist) whose role is to plan perioperative care. This involves postoperative care as well as preoperative care. The physician's role is particularly in assessing the level of risk and recommending measures to reduce that risk, in consultation with the patient and colleagues. It is not his or her role to clear the patient for surgery, which implies no risk at all. Most requests are specifically to help the anaesthetist in the assessment of perioperative risk with particular attention being paid to cardiac and respiratory disease.

Physiological reserve is an important concept in patients facing major or emergency surgery and in critical illness generally. The cardiovascular system in particular has to mount a compensatory response to the physiological stress. Patients who lack the ability to do this because of impaired organ function have increased mortality as demonstrated by the American Society of Anaesthesiologists' classification of disease severity (Box 10.1). Key components of the medical consultation are to:

• Find out the severity and stability of the disease in question.

• Specifically recommend measures to treat the disease, optimise the patient's function and reduce perioperative risk.

• Plan postoperative care with colleagues.

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