Sunday, August 26, 2018

When Should You Have a A Screening Colonoscopy? Preventive Care and Personal Responsibility


A man I had not met came to my office prepared for one of life’s most joyful pursuits – a screening colonoscopy.   Perhaps, this experience gives truth to the adage, ‘it’s better to give than receive’.
This man was 70-years-old and was about to undergo his first screening study of the colon, an exam that experts and others advise take place at age 50.  Let me do the math for you; he was 20 years too late. 

I performed my task with diligence and removed a large polyp.   While I believe that the lesion was still benign, we gastroenterologists prefer to discover your polyps when they are small.   Smaller lesions are nearly always benign and are safer to remove.

Afterwards, I chatted with the patient and his wife and I expressed some surprise that there had been a two decade delay of his colonoscopy.   (Readers would be amazed and amused at the creative excuses I’ve been offered over the years explaining delayed colonoscopies.  A popular one is “I’ve been so busy!”, as if this could justify a 5-year delay.)

At this point, his wife interjected and expressed that ‘no one ever told him to get it done.’  I interpreted this as an effort to defend her husband’s delay and also to give a poke to the medical profession, who must have been derelict in its responsibility to advise him.

‘Not so fast’, I thought to myself.   Of course, I was going to be polite and respectful, but a push back was in order.

'My doctor never told me smoking was bad for me.'

While I agreed with her that his primary care physician should have made a timely recommendation to pursue colon cancer screening (which for all I know may have happened), surely her husband was aware himself that he needed a colonoscopy.   The medical profession and numerous health organizations have been diligent and effective over the past few decades educating the public about colon cancer prevention   Folks don’t need a doctor’s advice or reminder on this any more than they do to wear seat belts or bicycle helmets. 

Personal responsibility is a virtue and a responsibility.   I don’t expect my patients to know how to treat Crohn’s disease and Hepatitis C.   And, I do my best to make sure that their colons don’t escape my attention.  But, it not all on me.   Would it be reasonable for a smoker today to keep puffing away because a doctor didn’t counsel about cigarettes' health risks?


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