A JAMA Internal Medicine review written for physicians who see patients before surgery argues for a stepwise approach rather than a one-word clearance.
It starts with reviewing known conditions and current medicines in the light of the planned operation, which can lead to specific risk-reduction steps and decide whether any test is actually needed. It then asks the physician to pursue new or unexplained findings, such as exertional breathlessness or signs of fluid overload, rather than file them. Finally it places weight on explaining individual risks and benefits and sharing decisions about preparation.
This is a narrative review, not new evidence, but it matches how surgical and anaesthetic teams use a physician's note. A note that names the risks, the changes made and what to watch for after surgery is worth more to them than 'fit for surgery'.
- Write what you assessed, what you changed and what to watch postoperatively, rather than 'cleared for surgery'.
- Order tests only when the result would change management, not routinely by age.
- Investigate new exertional breathlessness or signs of fluid overload before elective surgery.
- Discuss individual risks and benefits with the patient and family, including whether to proceed.
Why it matters
A clearance letter tells the surgical team nothing they can act on.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for internal medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free