Guest guest Posted December 28, 2004 Report Share Posted December 28, 2004 Hello all: Just curious if any of you evaluate patients pre-op and are expected to make judgments on whether they are good or bad surgical candidates....if so are you using any particular criteria, specific question or just an overall clinical judgment based on multiple factors? Also if anyone has any articles on the topic that would be great. All opinions and information are appreciated. Lastly, is anyone aware of task forces/committee/groups working to establish more specific guidelines for nutrition pre and post op? Is that something we should be working on? Cheers Laschkewitsch RD Legacy Obesity Institute Portland OR IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2004 Report Share Posted December 29, 2004 Now that you mention it, I thought that the ASBS subgroup was coming out with recommendations in October. I wonder what the status is on that? J. Sams MS RD/LD >From: " Laschkwitsch, :LPH Obes Inst " <KLaschke@...> >Reply- >< > >Subject: pre-op eval >Date: Tue, 28 Dec 2004 17:37:06 -0800 > >Hello all: > >Just curious if any of you evaluate patients pre-op and are expected to >make >judgments on whether they are good or bad surgical candidates....if so are >you using any particular criteria, specific question or just an overall >clinical judgment based on multiple factors? Also if anyone has any >articles on the topic that would be great. All opinions and information >are >appreciated. Lastly, is anyone aware of task forces/committee/groups >working to establish more specific guidelines for nutrition pre and post >op? >Is that something we should be working on? > >Cheers > > Laschkewitsch RD >Legacy Obesity Institute >Portland OR > > > >IMPORTANT NOTICE: This communication, including any attachment, contains >information that may be confidential or privileged, and is intended solely >for the entity or individual to whom it is addressed. If you are not the >intended recipient, you should contact the sender and delete the message. >Any unauthorized disclosure, copying, or distribution of this message is >strictly prohibited. Nothing in this email, including any attachment, is >intended to be a legally binding signature. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 3, 2005 Report Share Posted January 3, 2005 I have been patiently awaiting the same guidelines myself. I feel very legally exposed when doing these evaluations. If I " ok " someone and they have a bad outcome, am I at risk legally? Or if I deny someone the opportunity for surgery, they aren't going to be happy, and may try to retaliate. What I have tried to do so far is to make my evaluation, but not state that a patient is or is not a candidate for surgery. I allow the surgeon to make that call, not me. So my part of the preop evaluation is a summary of my visit with them and an evaluation of their nutrition knowledge, knowledge of the procedure and the lifestyle changes important after the surgery, etc. I may be in a different situation than some of you, as I am a consultant dietitian working in a small rural hospital. If I were working in a bariatric surgery center or if I were specializing in obesity treatment, I might feel more comfortable making the decision to approve/deny surgery,but currently I don't. > Hello all: > > Just curious if any of you evaluate patients pre-op and are expected to make > judgments on whether they are good or bad surgical candidates....if so are > you using any particular criteria, specific question or just an overall > clinical judgment based on multiple factors? Also if anyone has any > articles on the topic that would be great. All opinions and information are > appreciated. Lastly, is anyone aware of task forces/committee/groups > working to establish more specific guidelines for nutrition pre and post op? > Is that something we should be working on? > > Cheers > > Laschkewitsch RD > Legacy Obesity Institute > Portland OR > > > > IMPORTANT NOTICE: This communication, including any attachment, contains > information that may be confidential or privileged, and is intended solely > for the entity or individual to whom it is addressed. If you are not the > intended recipient, you should contact the sender and delete the message. > Any unauthorized disclosure, copying, or distribution of this message is > strictly prohibited. Nothing in this email, including any attachment, is > intended to be a legally binding signature. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2005 Report Share Posted January 4, 2005 I agree with Darla. I don't like being put in that position since I am not part of the bariatric team. I also work in a smaller, more rural hospital and my patients mostly go to Ohio State Medical Center. I often find myself troubled when I've worked with someone for 12 weeks in weight management and I just don't think they're putting forth much effort, but then the emotional side of me thinks about what their QOL must be like and what hope do they have for a better life without having the surgery. I remember one patient that I had a lot of concerns about her truthfulness and effort. The team had denied her and she ended up calling me in tears on the phone. Well, I felt completely put on the spot and after more discussion with her primary physician and another letter to OSU she was approved. I try to stress to patients at the beginning of the 12 week wt mgt program what the expectations are, but some of them see it only as a "hoop" to go through before they get what they really want. It can be very frustrating. I admit that being in a bariatric facility and serving as part of the overall team and being able to participate in discussions of the patients would be easier. The patients like to place blame on the person they've spent time with because obviously that is where the decision makers get their information. I try to provide a summary stating all areas of improvement and listing any areas of concern. That way I present the case and let them make judgment. It's certainly a tough place to sit when you're dealing with lives! Igleheart, MS, RD, LD Community Dietitian 1341 Street Cambridge, OH 43725 740.439.8941 -----Original Message-----From: darlawarfield [mailto:darlawarfield@...]Sent: Monday, January 03, 2005 7:07 PM Subject: Re: pre-op evalI have been patiently awaiting the same guidelines myself. I feel very legally exposed when doing these evaluations. If I "ok" someone and they have a bad outcome, am I at risk legally?Or if I deny someone the opportunity for surgery, they aren't going to be happy, and may try to retaliate. What I have tried to do so far is to make my evaluation, but not state that a patient is or is not a candidate for surgery. I allow the surgeon to make that call, not me. So my part of the preop evaluation is a summary of my visit with them and an evaluation of their nutrition knowledge, knowledge of the procedure and the lifestyle changes important after the surgery, etc. I may be in a different situation than some of you, as I am a consultant dietitian working in a small rural hospital. If I were working in a bariatric surgery center or if I were specializing in obesity treatment, I might feel more comfortable making the decision to approve/deny surgery,but currently I don't.> Hello all:> > Just curious if any of you evaluate patients pre-op and are expected to make> judgments on whether they are good or bad surgical candidates....if so are> you using any particular criteria, specific question or just an overall> clinical judgment based on multiple factors? Also if anyone has any> articles on the topic that would be great. All opinions and information are> appreciated. Lastly, is anyone aware of task forces/committee/groups> working to establish more specific guidelines for nutrition pre and post op?> Is that something we should be working on?> > Cheers> > Laschkewitsch RD> Legacy Obesity Institute> Portland OR> > > > IMPORTANT NOTICE: This communication, including any attachment, contains> information that may be confidential or privileged, and is intended solely> for the entity or individual to whom it is addressed. If you are not the> intended recipient, you should contact the sender and delete the message.> Any unauthorized disclosure, copying, or distribution of this message is> strictly prohibited. Nothing in this email, including any attachment, is> intended to be a legally binding signature. ******* DISCLAIMER ******* This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are notified that disclosing, copying, distributing or taking any action in reliance on the contents of this information is strictly prohibited. Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of the company. Finally, the recipient should check this email and any attachments for the presence of viruses. The company accepts no liability for any damage caused by viruses transmitted by this email. ******* END DISCLAIMER ******* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2005 Report Share Posted January 4, 2005 I approach the pre-op eval in a similar fashion. I do not see the psych eval - which is a critical part of determining a patient's appropriateness for the Bariatric procedure. I simple " state the facts " in my report: dieting history & response to weight loss attempts, an assessment of their knowledge & application of weight loss principles, diet history summary, use of nutritional supplements/herbs, physical activity history, & basic knowledge of bariatric procedures & lifestyle changes required, etc. The surgeon's office complies the evals & submits the profile for pre-authorization. I then see them again pre-op for in depth teaching. Joyce Joyce Buhler, R.D., C.D., C.D.E. Food & Nutrition Services Manager Valley Medical Center 151 West 1500 North, Vernal, UT 84078 435-789-3342 Ext 174 E-Mail: Joyce.Buhler@... Re: pre-op eval I have been patiently awaiting the same guidelines myself. I feel very legally exposed when doing these evaluations. If I " ok " someone and they have a bad outcome, am I at risk legally? Or if I deny someone the opportunity for surgery, they aren't going to be happy, and may try to retaliate. What I have tried to do so far is to make my evaluation, but not state that a patient is or is not a candidate for surgery. I allow the surgeon to make that call, not me. So my part of the preop evaluation is a summary of my visit with them and an evaluation of their nutrition knowledge, knowledge of the procedure and the lifestyle changes important after the surgery, etc. I may be in a different situation than some of you, as I am a consultant dietitian working in a small rural hospital. If I were working in a bariatric surgery center or if I were specializing in obesity treatment, I might feel more comfortable making the decision to approve/deny surgery,but currently I don't. > Hello all: > > Just curious if any of you evaluate patients pre-op and are expected to make > judgments on whether they are good or bad surgical candidates....if so are > you using any particular criteria, specific question or just an overall > clinical judgment based on multiple factors? Also if anyone has any > articles on the topic that would be great. All opinions and information are > appreciated. Lastly, is anyone aware of task forces/committee/groups > working to establish more specific guidelines for nutrition pre and post op? > Is that something we should be working on? > > Cheers > > Laschkewitsch RD > Legacy Obesity Institute > Portland OR > > > > IMPORTANT NOTICE: This communication, including any attachment, contains > information that may be confidential or privileged, and is intended solely > for the entity or individual to whom it is addressed. If you are not the > intended recipient, you should contact the sender and delete the message. > Any unauthorized disclosure, copying, or distribution of this message is > strictly prohibited. Nothing in this email, including any attachment, is > intended to be a legally binding signature. Quote Link to comment Share on other sites More sharing options...
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