To the Editor:
The article in the August 2016 issue of Anesthesiology, “ Preoperative Evaluation Clinic Visit Is Associated with Decreased Risk of In-hospital Postoperative Mortality” by Blitz et al.,1 brought back memories of my attempts at founding a preanesthetic clinic in the Bronx more than 40 yr ago.
With the help of an internist, Dr. Richard Collens, I started a program at the Bronx Municipal Hospital Center (New York City, New York), initially designed to help women. After leaving their children at school, women scheduled for surgery would come to the hospital where I would discuss their anesthesia with them, order appropriate tests, and perform a physical examination. Later in the day, they would return to see me as it was convenient for them, and I would discuss the results of their tests and we would schedule them for surgery. Patients quickly realized what they could expect, especially that they did not have to come in ahead of time for tests, and moreover, they did not have to spend longer postoperative time in the hospital. They actually told their surgeons that they were ready to go home now! Whenever possible, I either anesthetized the patients or followed up with them in the recovery room or telephoned them at home. The program was expanded to all patient populations within a few weeks. The program was also used by Bronx high school students as a type of elective to observe and follow patients.
Within 3 yr, we had gathered data on more than 3,500 patients. Inpatient hospital days were reduced in some cases by as much as 7 days. The situation was becoming critical for the hospital, and I was summoned to the director’s, Dr. Leonard Piccoli, office. He insisted that I close the clinic immediately as the hospital was losing money because there were so many empty beds; he would have to lay off personnel and even close Van Etten Hospital (an extension of Jacobi Hospital, New York City, New York). I was stunned as I believed after hearing so many comments from patients that we were doing a good service. As luck would have it, I shared a common driveway with the editor-in-chief of the New York Times, Seymour Topping. I took my story to him. He agreed it was a worthwhile program, and he sent one of his chief writers, Jane Brodie, to talk to me. The next day, the article on the clinic was the front-page news on the New York Times. Certain that my career had come to an end, I waited to hear from the director. Sure enough the next day, I awoke to the radio at 6:30 am. Mr. Piccoli was explaining about the wonderful new program that had been started in the Bronx. That morning I went to his office and most apologetically told him that I could not see the firing of so many people and I would close the clinic right away. In a panic, he ranted that I could not do that as Heraldo Rivera, one of the most outspoken journalists in New York, as well as several other reporters were coming that day to interview him and see the clinic. Again, I expressed my reluctance to cause economic difficulties. He insisted that I must keep the clinic going. Finally I capitulated, but only as long as he gave the Department of Anesthesiology $10,000/yr to run the program. And so the preanesthetic assessment clinic was established in the Bronx and became the precursor for the ambulatory center. Mr. Topping, who is now 92 yr, still remembers the incident with glee.
A lead article appeared in Anesthesia and Analgesia the following year.2 The study also merited an editorial comment as I recall.
I do not doubt that mortality is decreased as Blitz et al.1 show, “…shorter stays in hospital are always a good idea.” Also, empowering patients to understand what they might expect and involving them in their own care are situations that are invaluable.
The author declares no competing interests.