Spinal surgery: Who is in charge anyway?

BACKGROUND: More and more, no one seems to be in charge of taking care of patients with spinal disease both before and after spine surgery. Yet, as spine surgeons, we should not have to direct basic medical clearance prior to surgery, or direct basic medical postoperative care. METHODS: As we as spine surgeons did not complete medical residencies, why are we now being asked to take care of all postoperative issues in our patients undergoing spine surgery. As “captains of the ship,” we are increasingly managing hypertension, diabetes, deep venous thrombosis/pulmonary embolism, and other basic medical issues. RESULTS: Although our medical colleagues perform the preoperative clearance, too frequently they are not involved in the patients’ follow-up treatment. Often, our medical colleagues are nowhere to be found after surgery for any of the postoperative problems; therefore, “tag” we are it. Nevertheless, this should not be the case. CONCLUSIONS: So I ask again, who's in charge? Are we as spine surgeons now supposed to become the patients’ primary care physicians, their pulmonologists, cardiologists, pain management specialists, much less their psychiatrists. Unfortunately, if we don’t do this, no one else appears to be willing to step.