# Talking to Doctor/Surgeon about Pre Op Screening **URL:** \ **Category:** Medical Q&A \[Moderated\]\ **Created:** [July 16, 2019, 8:53pm UTC](https://forum.barbellmedicine.com/t/talking-to-doctor-surgeon-about-pre-op-screening/6484 "2019-07-16T20:53:32Z")\ **Posts on this page:** 3\ **Page:** 1
**Author:** ![esamak](https://avatars.discourse-cdn.com/v4/letter/e/7bcc69/32.png) [@esamak](https://forum.barbellmedicine.com/u/esamak)\ **Post date:** [July 16, 2019, 8:53pm UTC](https://forum.barbellmedicine.com/t/talking-to-doctor-surgeon-about-pre-op-screening/6484/1 "2019-07-16T20:53:32Z")
I’ve got a septoplasty coming up in a few weeks. I have had inconsistent restfulness after sleep for a number of years now and after speaking with my doctor about my inability to breathe through my nose when I lie down, he referred me to an ENT. After conservative management was tried (Flonase with breathe right strip before bed), the ENT recommended surgery. I have not yet had a sleep study to confirm whether or not this was actual sleep apnea. I have my pre op appointment tomorrow and the surgeon has ordered a chest x-ray. I’m doing some reading and read through the [AAFP guidelines](https://www.aafp.org/afp/2013/0315/p414.html), “There is no high-quality evidence on the effectiveness of routine preoperative chest radiography.” The only risk factor for me is the fact that surgery is being done in my nose. Even still, AAFP gives a “C” rating to risk factors being a reason to do a chest x-ray. I don’t have any other risk factors as mentioned in the article (I’m a 26 year old male, not obese, not diabetec/prediabetic, childhood history of asthma but no symptoms or medication used for this since childhood). I’m also concerned about the possibility that false positives on chest x-rays can trigger unnecessary tests, anxiety, and a delay in the surgical procedure. Am I on the right track as far as the current recommendations? How can I talk with my physician about this? My PCP will be doing the screening. I’m not a physician myself and am not sure how to approach this topic. Some other sources I came across: > **[Value of routine pre-operative chest X-ray in patients over the age of 40...](https://pubmed.ncbi.nlm.nih.gov/9510631/)** > > The overall usefulness of routine chest X-ray, its cost benefit ratio and effect on anaesthetic management in patients over the age of 40 years was assessed. Four hundred and seventy-seven consecutive patients undergoing elective non-cardiopulmonary... > **[Usefulness of routine chest X-ray in preoperative... : European Journal of...](https://journals.lww.com/ejanaesthesiology/Fulltext/2012/06001/Usefulness_of_routine_chest_X_ray_in_preoperative.52.aspx)** > > An abstract is unavailable. > **[Preoperative Chest X-rays: A Teachable Moment](https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1741893)** > > Mr X, a man in his mid 50s with a history of mild intermittent asthma and an increasingly painful umbilical hernia, presented to a general surgery clinic for a preoperative evaluation. Basic laboratory test results and cardiopulmonary examination... ---
**Author:** ![Austin\_Baraki](https://sea1.discourse-cdn.com/flex001/user_avatar/forum.barbellmedicine.com/austin_baraki/32/1095_2.png) [@Austin\_Baraki](https://forum.barbellmedicine.com/u/Austin_Baraki)\ **Post date:** [July 16, 2019, 9:42pm UTC](https://forum.barbellmedicine.com/t/talking-to-doctor-surgeon-about-pre-op-screening/6484/2 "2019-07-16T21:42:40Z")
While I cannot comment on your specific case, it is unlikely that routine pre-operative chest x-ray in this situation would be helpful. On the other hand, sometimes surgeons specifically request certain tests (even if not medically indicated according to guidelines), and may refuse to perform the surgery without it. This is a frustrating situation we sometimes find ourselves in. ---
**Author:** ![esamak](https://avatars.discourse-cdn.com/v4/letter/e/7bcc69/32.png) [@esamak](https://forum.barbellmedicine.com/u/esamak)\ **Post date:** [July 16, 2019, 10:13pm UTC](https://forum.barbellmedicine.com/t/talking-to-doctor-surgeon-about-pre-op-screening/6484/3 "2019-07-16T22:13:51Z")
It seems like it might indeed be the case that the surgeon or anesthesiologist might refuse to perform the surgery without the requested tests within the requested window of time. I appreciate your input, regardless.