I spent Thursday in preassessment clinic, that peculiar purgatory where we attempt to predict whether patients will survive their upcoming surgery based on a fifteen-minute conversation and some blood tests from three months ago.

The clinic runs on a simple principle: every patient believes they are “fit and well,” and our job is to gently disabuse them of this notion.

“Apart from…”

The most dangerous words in preassessment are “apart from.” They herald a cascade of medical history that somehow didn’t make it into the referral letter.

Me: “So, any medical problems?”

Patient: “No, I’m fit as a fiddle. Apart from the diabetes.”

Me: “Right, diabetes. Anything else?”

Patient: “Well, the heart thing.”

Me: “The heart thing?”

Patient: “You know, the bypass.”

Me: “You had a bypass?”

Patient: “Four years ago. And the pacemaker.”

Me: “…”

Patient: “But otherwise I’m perfectly healthy. My wife says I’m a hypochondriac.”

By the end of these consultations, I’ve filled three pages of notes and the “fit and well” patient has revealed themselves to be a walking compendium of comorbidities. This isn’t their fault—most people genuinely don’t realise that a coronary artery bypass graft counts as a “medical problem.” They survived it, didn’t they? Ergo, no problem.

The fasting patient

Nothing tests my patience quite like the patient who hasn’t fasted despite being told to, and then looks at me as though I’m the unreasonable one.

“But it was just a biscuit.”

Yes, but that biscuit is the reason we’re now delaying your operation while your gastric contents sit there like a reservoir of aspiration waiting to happen.

I explain this carefully, using words like “stomach contents” and “lungs” and “very bad.” They nod. They understand. They won’t do it again.

They will absolutely do it again.

The eternal question

Every clinic ends the same way: a patient asking the one question we cannot answer.

“So, doctor, am I going to be alright?”

What I want to say: “I don’t know. Medicine is uncertainty dressed up as confidence. I can tell you the statistics, but you’re not a statistic, you’re a person, and people are wonderfully unpredictable.”

What I actually say: “The surgery has good outcomes and we’ll take very good care of you.”

It’s not a lie, exactly. It’s optimism. We’re good at that, in medicine. We have to be.

Now, if you’ll excuse me, I need to track down some blood results and find out why the referral letter described this morning’s patient as “no past medical history” when he’s apparently on seventeen different medications.

Another day in the NHS.