To the Editor:-Fischer [1]recently described the Anesthesia Preoperative Evaluation Clinic at Stanford, in which the unavailability of anesthesia attendings or residents for preoperative visits led to the delegation of many responsibilities to a nurse practitioner. At Stanford, the nurse “determines the suitability of the patient's condition for anesthesia and surgery,”“performs a complete preoperative physical examination,” and “informs the patient about options for anesthesia and postoperative pain control.”
Last year, and in many prior years, the American Society of Anesthesiologists prevailed upon the U.S. Congress to leave intact the Medicare rules of participation that address the essential elements of an anesthesiologist's care. The leaders of our specialty successfully argued that these elements represent the practice of medicine. The elements prescribed by law*(and outlined in our Society's Guidelines on the Ethical Practice of Anesthesiology) include the preanesthetic examination and evaluation, and the prescription of the anesthetic plan.
Deutschman and Traber [2]editorialize that anesthesiologists are “unrecognized or misunderstood by our patients, our colleagues, and the public.” I would agree entirely with this assessment, but conclude that the practices described by Fischer undoubtedly exacerbate these problems and make it impossible for anesthesiologists to argue that perioperative care is the practice of medicine. Fischer and his colleagues at Stanford have delegated to nurses precisely the tasks that federal statute and our code of ethics define as the physician's responsibility. To establish our credentials as perioperative physicians, patients and our colleagues must see our involvement in these aspects of care on a regular basis.
Alexander A. Hannenberg, M.D., Newton Wellesley Hospital, Tufts University School of Medicine, Massachusetts 02162.
(Accepted for publication October, 10, 1996.)
*42 CFR 405.552.
