The Referring Physician-Surgeon Relationship
As the referring physician, you often initiate the weight loss discussion with your patients; accordingly, it is important to establish a relationship with a bariatric surgeon to whom you will refer your patients. Ongoing communication with the bariatric surgeon may be necessary, and in some cases you may need to provide medical clearance. If a letter of medical necessity is required by the patient for insurance or other purpose you can download here.
Although the surgeon is responsible for the ongoing surgical aftercare, as the referring physician you should remain actively involved in your patient's ongoing medical care to manage any obesity-related risk factors. You will also want to be aware of the potential post-operative complications and related symptoms.
Indications for Post-operative Complications
- New, sustained pulse rate of more than 120 beats/min for at least four hours
- Inadequate weight loss
- Persistent severe gastrointestinal symptoms (diarrhea, vomiting, nausea, abdominal pain)
- Malnutrition
Criteria for post-operative hospital admission include:
- Severe malnutrition
- Gastrointestinal complications in patients not amenable or responsive to medical therapy
Revision or removal is recommended in the following circumstances:
- Presence of medical complications clearly resulting from the surgical process and not amenable or responsive to medical therapy (for example, malnutrition)
- Inadequate weight loss or weight regain in patients with persistent weight-related comorbidities who previously underwent a restrictive process
- When serious complications related to previous bariatric surgery cannot be managed medically and are not amenable to surgical revision
This list is not exhaustive and best medical judgment should prevail
