Last week, a patient arrived at our endoscopy suite for a procedure on her pancreas. She'd been on our schedule for two weeks. Her chart clearly documented significant ascites (fluid buildup in her abdomen) that we'd known about for over a month. But nobody had coordinated drainage before her procedure day.


We scrambled. Made calls. Delayed the case. Kept her NPO [nothing by mouth] longer than necessary while her family sat in the waiting room, confused about why a documented problem suddenly became an emergency.


This shouldn't be remarkable. At most hospitals, it's just Tuesday.


For years, I accepted this as the cost of doing business in perioperative care. We had workarounds for everything: missing documentation, last-minute clearances, patients who
arrived with uncontrolled comorbidities that had been sitting in their chart for weeks. We got pretty good at the workarounds. We took pride in our ability to adapt, to make it work despite the chaos.
 Then the glass broke for me. Workarounds aren't healthcare. They're evidence of broken systems that we've normalized because we've run out of bandwidth to fix them.

Here's what nobody tells you about being an anesthesiologist: Most of your day isn't medicine. It's navigating around obstacles that shouldn't exist.


Every patient interaction involves dozens of micro-decisions that have nothing to do with clinical care. Finding the right form in the EHR. Tracking down a specialist's note that should have been filed weeks ago. Calling the same patient three times because they missed the portal message about stopping their GLP-1 medication. Documenting the same information in multiple places because systems don't talk to each other.


These aren't small inefficiencies. They're deaths by a thousand cuts. And in perioperative care, they don't just waste time, they create real risk. When your Pre-Admission Testing (PAT) nurse is spending 40% of their day chasing documentation, she's not doing what she's actually trained to do: clinical assessment and patient education. When patients slip through the cracks, they show up unprepared, and we either cancel (devastating for surgical oncology patients) or proceed with elevated risk.


The really insidious part? We've built entire roles around these workarounds. We hire coordinators to coordinate coordinators. We create committees to discuss why our processes don't work. We implement new EHR modules that promise to fix things but actually just add more clicks.

Here's what keeps me up at night: We've become so accustomed to dysfunction that "good enough" has become our standard. The EHR has a module for preoperative assessment? Good enough. We have a patient portal they can use? Good enough. Our cancellation rate is only 8%? Good enough.


But "good enough" isn't good enough when you look at what it actually means for patients. For surgical oncology patients, it means delayed cancer treatment, unnecessary anxiety, and worse outcomes because we didn't optimize them when we had the chance. For neurosurgery patients, it means postponing time-sensitive procedures where every day matters. For orthopedic patients, it means extended periods of pain and immobility while waiting for a rescheduled joint replacement. For pediatric patients, it means multiple rounds of fasting and family disruption, creating trauma around an already stressful experience.