Pre‐anaesthesia assessment clinics

I wish to give balance to the letter from Dr Cosgrove (Cosgrove. Anaesthesia 2000; 55: 405–6) in which he/she expounds the virtues of the pre-anaesthetic clinics, which have been foisted on us by a minority. Although there are advantages in terms of the logistics of patient admission and throughput, Dr Cosgrove's claim that this has ‘enhanced our role as peri-operative physicians and (resulted in) improved training’ is certainly untested. Often these clinics are performed by trainees (certainly not supervised) who are faced with not only assessing patients whom they will not anaesthetise, but also often a significant number of them. Only the most credulous of us would believe that this would result in a concerned and detailed assessment of the patient and ‘allow the trainee an opportunity to refine the skills of history taking and examination …’ A brief discussion with any trainee quickly reveals the perception of these clinics as a chore – to be completed in the shortest period. The trainee, or indeed the consultant (often semi-retired), has no personal responsibility for the patient and his/her forthcoming anaesthetic care, and it is difficult for them to be as thorough and as interested as they might be, however much we might wish it otherwise. Another problem is that the person assessing the patient often has little idea of the proclivities of the anaesthetist who will actually be providing the anaesthetic service. This means that such things as pre-operative medication, induction techniques and potential postoperative analgesic techniques are either not discussed, or have to be discussed in general, thereby reducing the patient's information and knowledge about the anaesthetic technique. This can result in a ‘rushed consultation’ in the anaesthetic bay – something Dr Cosgrove claims has been prevented. In my opinion these clinics, while having some good points (I can now go home earlier at night – my patients are not in hospital!), have not necessarily resulted in improved patient care, and have certainly not resulted in improved anaesthetist–patient relationships. There is no evidence that there is ‘an improved patient perspective of their admission’ nor have the clinics been shown to contribute ‘towards anxiolysis and increased patient awareness of the role of the anaesthetist.’ Many anaesthetists have complained bitterly at the introduction of these clinics, seeing them as taking away their traditional ability to see their own patients at their own pace. Undoubtedly, this form of medical practice will continue to increase; certainly it is cost-effective. Unfortunately, it forces us more and more towards the ‘sausage factory’ concept of getting patients through the system without identifying them as individuals.