On the last occasion we spoke with our guest she was a Perioperative Medicine Fellow at Duke University; learn now how her experiences have helped change her practice and the edge she has dealing with healthcare.   The conference is producing a number of talking points, the Measurement of Exercise Tolerance before Surgery (METS) Trial seems to have shifted opinions, does a genuine ‘perioptimist’ have a deeper insight into the issues there?   Also – does North America really lack the resources, expertise and money to adpot Cardiopulmonary Exercise Testing (CPET)?   Presented by Desiree Chappell and Monty Mythen with their guest Dr Elena Koepke, Assistant Professor at Moffitt Cancer Center/USF, Physician Anesthesiologist, Perioperative Medicine Specialist.   You can find POETTS here: https://www.poetts.co.uk