Earth to Dr. Ozner . . . When was the last time in recent years that you heard of a patient being actually admitted to a hospital for routine foot surgery? It's no longer a option unless patient wants to foot his/her own bill.
As far as pre-operative test and medical evaluations are concerned, I suppose that there may be differences in hospital protocals in different areas of the country, but where I practice, unless gas general anesthesia is envolved, chest x-rays are not mandated and without pre-existing cardiac disease, routine EKG are not either. These tests are generally required by the Department of Anesthesia if general is to be used, as it is by far the area of the procedure fraught with the most potential danger. It is only prudent to assure that the patient is up to it. Having said that, even under straight local anesthesia, it is prudent to perform some basic blood test to assure that there is nothing serious but hidden going on with the patient which should be resolved and/or addressed prior to surgery.
As far as infection rates are concerned in foot surgery, there is less of that now that just about all procedures are done on an out patient basis . . though, the short term stays previously employed with foot surgery in years past did not lend themselves to that much of a problem. I've had exceedingly few post operative infections over the many years I've practiced. More often than not, the etiology of most post-surgical infects is the poor handling of tissues leading to their unnecessary traumatization and thus degrading their viability and increasing their susceptibility to bacterial growth. This can happen both with open or closed procedures and the main mitigating factor is the skill of the surgeon, not the method of surgery.
Lastly, no doctor should let patients dictate by their "DEMAMDS" the appropriate method of perfoming a surgical procedure. Doctors offices are not retail facilities where the "customer is always right." Patients come to me for my expertise, my reputation and my skill. In in end, it is I who will be held accountable for their care and "you made me do it" simply doesn't wash. I would rather lose the patient than give them the best I have . . even if they DEMAND it. |
