Residents and Surgical ClinicResidents and Surgical Clinic

To the Editor: I am concerned that some readers might interpret the role of surgical residents in American outpatient care as being uneducational and not contributory to patient care when compared with the experiences in third-world settings described in Dr Capriotti’s essay “Clinic.”¹

This week in my own surgical clinic, the attentive and comprehensive preoperative work of residents led to discovery of an unsuspected abscess on examination of one patient, and identification of coronary insufficiency on interview of another, both of which had major impact on the subsequent courses of these patients. Far from perfunctory, the surgical assessments and preoperative history and physical examinations needed to satisfy legal, regulatory, and payer requirements are clinically indispensable. Synthesis of a comprehensive medical profile permits thorough evaluation of the problem and assessment of the overall medical condition, including the relative risks and benefits of potential interventions; it thus serves as the basis for informed consent. In the absence of a centralized medical record, our job in trying to prepare patients for an optimal course through anesthesia and surgery includes overcoming the hazards of imperfect communication among physicians or from patients who may have difficulty relating which medications they take or other important historical data. While a surgical trainee may understandably view the tasks of completing seemingly endless paperwork and screening myriad preoperative patients as unglamorous scutwork, in fact there is the constant opportunity to make a difference.