Skip to main content

New Indication for Colonoscopy: High Value Target Captured.

This past week, I had a once-in-a-career event.  Indeed, if I didn’t already author a blog, this episode would have been the catalyst to begin one.   As I write this, I am not certain which category label to assign to this post.  I will likely include it in General Whistleblowing rather than create a new category called Search and Rescue.

Gastroenterologists are not just healers of the alimentary canal.  Yes, we are consumed with issues of mastication, salivation, rumination, trituration (GI power word), secretion, digestion, propulsion and elimination.  But, we are so much more than this.  We are poised to serve humanity in so many ways beyond medicine.
The colonoscope is mankind’s Holy Grail. 

Please study the photograph below carefully.  When we were medical students peering at a chest x-ray while the attending physician hovered behind us, we were told that “the answer is on the film”.  Of course, we always missed the diagnosis.  We would focus on the heart and lungs and ignore a lesion that was in the shoulder bone at the periphery of the film.  So, dear readers, study this photo.  As a gesture of extreme generosity, I will disclose that this is a photograph of the cecum, which is the blind sac at the upper part of the large intestine where the appendix originates.  “The answer is on the photograph”.

Three weeks before this individual enjoyed the pleasure of colonoscopic intrusion, he swallowed an item that was of great personal value.  How valuable?  Valuable enough that this man strained his stools during this period with the hope of capturing the buried treasure.  Nice visual, huh?

An astute nurse, who knew the lost item’s identity, thought that what is seen in the above photograph was a bulls-eye.  The excitement in the endoscopy suite was a crescendo.   Was this stowaway in the cecum a piece of food or something far more desirable?

I then relied upon decades of medical experience for guidance.   I elected to retrieve the item and subject it to strict scrutiny.  I passed a gastroenterologist’s version of a miniature butterfly net through the colonoscope and performed a successful extraction.

Once we cleaned it up a bit, it was easy to recognize this man’s porcelain dental crown.  Once he awoke, he was joyful to be reunited with this evasive escapee.

I’ve removed thousands of polyps from the colon.  I’ve taken thousands of biopsies from all kinds of lesions.  I’ve seen worms wriggling inside a colon that became their new home.  I’ve used the colonoscope to investigate bleeding, diarrhea, bowel issues and abdominal pain.  But, with this man, I enjoyed a singular accomplishment.  It was my crowning achievement.

Photos published with permission.


  1. Impressed to know the new indication of colonoscopy, thanks


Post a Comment

Popular posts from this blog

Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today

Electronic Medical Records vs Physicians: Not a Fair Fight!

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary