I spend more than half of my work week performing endoscopic procedures, the majority of which are colonoscopies. Many of these colon exams are screening colonoscopies, meaning exams performed in the absence of any symptoms, an effort to reduce colon cancer risk. This is in contrast to diagnostic colonoscopies which are performed to evaluate symptoms or abnormal lab values such as a low blood count or anemia. Whether I am performing a screening or a diagnostic exam has no effect on the patient’s experience. However, it may make a huge difference to the insurance company and your out-of-pocket financial obligations. But I digress…
Many of my procedure patients have previously seen me in the
office for consultations. In other
words, they are my patients. It’s likely
that after their procedures that they will be advised to return to my office
for continued conversations on their condition. However, many procedure patients are unknown
to me and are referred by other medical professionals. We label these procedure patients as Open
Access (OA). For example, an internist may have evaluated a patient with
abdominal pain and ordered a
scope exam of the esophagus and stomach region. The patient will land wherever there is a vacant slot. Often, I am that gastroenterologist.
I handle OA patients very differently than I do my own
patients. In OA cases, I have been
tasked to perform a technical function and not to render a medical opinion. Therefore, I will not provide OA patients with medical advice unless
the procedure findings clearly call for an immediate response.
For example, if I discover an ulcer, I will prescribe an appropriate
medicine but will refer the patient directly back to the referring
professional. If however, the OA patient
has chronic nausea and abdominal pain and my scope exam is normal, I will not
be engaging in a conversation regarding potential next steps. The referring professional will direct these discussions.
A piano tuner performs a technical function.
Don't expect that he will provide music lessons.
Similarly, when a patient undergoes a CAT scan of the
abdomen, the radiologist – who is a board certified physician – generally does not
give medical advice after the test. The
patient is directed back to the referring practitioner to discuss the scan
findings in context of the patient’s medical circumstances.
At times, OA patients and their families assume that I will
involve myself in their care since I am an actual gastroenterologist. But I am not serving as their
gastroenterologist or physician. I have
used the phrase with them, we’re only the scope team, which I have learned has been
co-opted by several of my gastroenterology colleagues.
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How do you accept the fact that on occasion you are called for your opinion on your own patients and on other occasions such as these OA’s, you obviously have opinions and yet you do not divulge them? Is this not duplicitous on your part?
ReplyDelete@anonymous, thanks for reaching out. I view my role in OA patients as a technician. I have not seen these patients in the office for a formal consultation when i diligently review the record, interview the patient and perform a physical examination. After all of this, I offer my opinion and advice. OA endoscopy patients are referred by medical professionals to the procedure only. If medical advice was the objective, then an office consultation would have been arranged. Similarly, when a patient is referred for a CAT scan, the radiologist interprets the images and sends the report to the ordering professional. He or she doesn't give direct medical advice to the patient.
ReplyDeleteI completely agree with Dr. Kirsch. As a sleep physician, I cringe when I see sleep study reports with an "interpretation" of the study recommending sleep apnea surgery, weight loss, sleeping on one's side, dental appliance, or even treatment of periodic limb movements, etc. with absolutely no knowledge or context of these often misleading and potentially harmful forms of advice (e.g. dangerous, permanent, and rarely effective surgical procedures). Medical advice should be given in the context of a complete clinical evaluation, not a technical interpretation of a test.
ReplyDelete@anonymous, well said!
ReplyDelete