Patients understandably focus on who will be managing the scope during their procedure. They expect that the proceduralist – a physician, at least so far – is a highly skilled practitioner. They want accuracy and safety. Indeed, from time to time, after I have reviewed the risks of colonoscopy, a patient will query me directly on my complication rate, particularly with regard to the dreaded event of a bowel puncture. They are hoping to hear, of course, that I have never had a procedural misadventure, but I point out that the only gastroenterologists who haven’t been involved in a complication are new specialists who are just starting out. This is a mathematical issue. If the perforation rate is 1/2500 cases, and the GI physician has performed 20,000 procedures, then there will have been some adverse events. As an aside, the term complication does not imply culpability. They are blameless events that occur at low frequency despite the med...
As I begin this post, the federal government has been shut down for several days.. Neither the Democrats nor the Republicans were able to reach the 60 vote threshold in the U.S. Senate to advance their respective legislative plans. The GOP insisted that a ‘clean’ continuing resolution (CR) be passed without conditions. Democrats demanded that the government extend expiring Affordable Care Act (Obamacare) subsidies enacted during the pandemic, and restore Medicaid cuts contained in Trump’s One Big Beautiful Bill Act passed months ago as the price of their CR support. The GOP expressed willingness to discuss these health issues, but only if a clean CR is passed first. The Democrats countered that tying their legislative priorities to the CR gives them leverage to achieve their desired health policy objectives. Interestingly, this past March, many Democrats supported a clean CR without adding on their legislative preferences. Hmm… By the time this is p...