The Who-What-When and Where's of Bariatric Follow Up

Photo by M Clock

Follow up.

Common for medical practices, usually less so for surgical practices.  Bariatric surgery is different. We get to know our patients very well, starting with a number of preoperative visits in preparation for surgery. We often comment that our 'surgical' practice is more like Family Practice as far as follow up goes.

We have heard from more than a few referring practices commenting that staying aware of how their patients are doing can be challenging.  We are moving forward to an EMR early 2013 which should help greatly.  For the time being, we try and send notes through our transcription service, but admittedly it can be inefficient at times. All labs are currently CC'd to the PCPs to keep you in the loop.  This is an area we are working on to improve in our practice.

You as the PCP still retain control over the patient's medical condition for all things, while we see them for surgery-related issues, for both acute care and regular follow up. There can be times of overlap, and our goal is to stay in touch and communicate effectively with you if we get in to a grey area as far as HTN or DM management, or an issue such as anticoagulation is concerned.  

All our patients follow a pretty set schedule of follow up.  Bypasses and Sleeves come in for a 1 week post op check, then 3 weeks later for a 1 month check.  After that, we see them at 3, 6, 9, and 12 mos post surgery, and then every 6 - 12 mos thereafter as well, long term.  We draw labs starting at the 3 mos check, and usually check blood work at each successive visit there after. Again, we do CC all labs to the PCPs to allow you to stay informed of any issues that may arise. 

Our Band patients are a little different.  We also see them 1 week and 1 mos post op, and we start adjusting their Bands at that 1 mos post op visit.  We usually see them every 3 - 4 weeks thereafter for re-evals, and adjustments as needed.  Once their Bands (and their behavior) are tuned up and they are on track, we can safely stretch out their visits.  Given that the Band is much less likely to produce nutritional / micronutrient deficiencies, labs are done a little less frequently, usually around 6 mos and 12 mos after their surgery, or as needed if clinically indicated.  Our Band patients know that if they are in need of an acute visit, we can see them usually the same day to remedy an over tight Band, or within a few days if they have any issues of lesser acuity.

As most of you are aware, we are available daily M - F to see patients acutely for a 'sick visit', for an acute Bariatric issue, or one that is suspected to be so.  We are always available to speak with you on the phone if you have a patient management question or a Bariatric issue that needs attention.  Ask to speak with our Nurse Clinical Coordinator, or myself at 518-831-7001 as needed.  We will be happy to take the call.

Coming in the next post is an interesting issue that is fairly common in follow up after a Gastric Bypass, and can lead to both acute problems and long term frustration in the form of weight regain - Hypoglycemia.