Doctor Explains Pre-Surgery Fasting Amid Patient Complaint

A recent online dispute, initiated by a patient's public criticism of a doctor regarding a lengthy pre-surgery fasting period, has ignited a broader conversation about doctor-patient relationships. The patient claimed to have fasted for 29 hours, including 13 hours in the hospital, without undergoing the scheduled surgery, and accused the doctor of "feasting."

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Pre-operative 'fasting' is for anesthesia safety, preventing vomiting when a patient is unconscious, which could lead to fatal aspiration pneumonia if stomach contents enter the lungs.

Dr. Chen Chih-chin, from the Intensive Care Medicine Department at Chi Mei Hospital, addressed the situation on his Facebook page, "ICU Doctor Chen Chih-chin." He explained that pre-operative "fasting" is primarily for anesthesia safety. It prevents vomiting when a patient is unconscious, which could lead to fatal aspiration pneumonia if stomach contents enter the lungs. Even with regional anesthesia, where the patient is awake, fasting is generally required because a switch to general anesthesia might become necessary during the procedure.

Dr. Chen clarified the typical fasting guidelines: clear liquids up to two hours before surgery, light meals like toast up to six hours prior, and full meals or fatty foods at least eight hours in advance. To simplify management, many hospitals enforce a "Midnight NPO" (Nil Per Os, nothing by mouth) policy from midnight until the surgery. This can mean fasting for over 12 hours, especially for afternoon surgeries. He also noted that "fasting" in this context doesn't mean complete abstinence from sustenance; patients receive IV fluids and glucose, preventing dehydration or low blood sugar.

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The patient might misunderstand: 'I can't have surgery now because my doctor is still operating on another patient.' In reality, the doctor might also be waiting for an available operating room slot.

The doctor further explained the complexities of hospital "surgery scheduling," or "排刀" (pai dao). Senior surgeons may have dedicated operating days, offering more predictable times. However, delays are common due to previous surgeries running long or unexpected complications. For non-emergency procedures, especially shorter ones like tracheotomies or myomectomies, surgeons often wait for available "slots" (空檔, kong dang), sometimes referred to as TF1, TF2, etc. If a slot doesn't materialize by the end of the day, the surgery might be canceled and rescheduled. Dr. Chen emphasized that explaining these possibilities upfront helps manage patient expectations and reduce disappointment. He also addressed the "feasting" accusation, suggesting that doctors waiting for surgery slots are often stable and eating to maintain energy for their work, and that their time is also constrained by the unpredictable schedule.

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If you can't eat, then the doctor shouldn't eat either? Then the doctor might experience hypoglycemia during your surgery, which is even more dangerous for you, isn't it?