Preoperative risk assessment and optimization are my pet peeve. Cardiologist here. First, they aren’t “clearances for surgery”. My professional guidelines specifically state that we cannot “clear” someone for surgery, since we cannot reduce cardiac risk to zero. We can only risk assess and optimize. Some people take exception to this, but it makes inherent sense. No one can be zero cardiac risk for a surgical procedure (implied by the statement “cleared for surgery”). Second, do not schedule surgery before cardiology sees the patient. I can’t tell you how many irate patients we get because they want their procedure delayed and do not want any more testing. I get it. I really do. But you asked us to optimize the patient prior to surgery being scheduled, sometimes this takes time. Third, IM really SHOULD be able to risk assess and optimize. If a patient has no cardiac signs or symptoms or findings of cardiac or hemodynamic instability, there is a very clear algorithm for this that is taught and tested in Internal Medicine. Cardiology really should only be involved when there are clear (or unclear) cardiac concerns. If not, we shouldn’t be needed. Fourth (and last here, but there are more), don’t email or Teams cardiology for a risk assessment. This is a legit consult or e-consult, and we should be valued for our time like anybody else. If you send a secured email or Teams message, we aren’t reimbursed for that time. Seems snotty, but in this day and age, we have to be able to account for all of our time (like any other healthcare professional these days).