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Now we get to the pathetic weasel excuses. I didn't
make these up, I have given this talk, many, many times and somebody
always asks these questions. "I don't want the responsibility of starting a drug that will need to be followed up post op." Well, let's deal with this problem. Do you care about operative mortality? If you want to lower the risk of death in the patients you provide care for, you will need to administer drugs that will continue into the post operative period. You are responsible for the care you provide and don't provide. It violates the standard of care to not administer perioperative beta blockers to patients with known coronary artery disease or known vascular disease. You are responsible for their care, you had better start the drug. On the good side, there isn't much to follow. You prescribe the drug and the patient takes it and they don't die or have a heart attack. What is their to follow? "I get paid for the day of surgery, not to
follow a patient post op." I am amazed when doctors tell
me this. In the VA I get paid by the year. I don't get paid by
the case. I still provide good care. If you care about the patient,
if you care about reducing the risk of death, you will provide
good perioperative care. This care implies giving BBAC medications
prior to surgery and continuing them in the post operative period.
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"I don't want to get blamed for post op issues." This is really simple. If you don't prescribe BBAC medications and the patient has a heart attack or dies, you will get blamed. In the last eight years at the VA San Francisco we have operated on 3000 patients a year under the BBAC protocol. Not once has anyone been blamed for a problem related to giving perioperative beta blockers or clonidine. That being said, a number of patients have had heart attacks who were not on BBAC medications and those physicians were blamed for the MI or death. "Who is going to follow up on this medication?" The surgical patient has a surgeon, an anesthesiologist, and most likely an internist or cardiologist or primary care doctor or nurse practitioner. The BBAC medications will be followed like all the other medications the patient takes. In patients with known coronary artery disease, if you start a beta blocker, you are providing one of the known medications that prolongs life in this population. They should be on the beta blocker for the rest of their life. In patients with peripheral vascular disease, they all have coronary artery disease and should be on the beta blocker for the rest of their life. For patients with risk, the medications can be continued or discontinued by the surgeons at the post op visit or by the patients primary care physician. Do not avoid giving a BBAC medication because you fear some follow-up problem. Give the medication and reduce the risk of death.
 If audio does not begin after two minutes, please click the speaker icon above for narration.
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"I
don't want the responsibility of starting a drug that will
need to be followed up post op." 
"I
get paid for the day of surgery, not to follow a patient post
op."
"I
don't want to get blamed for post op issues."
"Who
is going to follow up on this medication?"
