Which doctor should do my colonoscopy?

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 medical professionals having done everything right.  If, however, a physician practices beyond his or her knowledge and training, or violates established medical protocols, and an adverse event occurs, then this may no longer be a blameless event. This may be a negligent act. The public often misunderstands this distinction.  They often assume that if an unfavorable outcome develops, then someone must have screwed up.  

Consider this dialogue between the the doctor and his patent, Joe.

Physician:  Joe, are you allergic to anything?

Joe:  Nope, I'm clean.

Physician:   OK, I'm prescribing some antibiotics for you.

Joe (3 days later)  Hey, doc., I have a rash on my chest and arms.  What's up?

Joe's rash is an example of a blameless allergic complication,

Like football, medicine is a team sport.

So, circling back to the title of this post, this is the wrong question to ask.  I work with a highly professional team of administrative staff and medical personnel, all of whom are essential in delivering a high quality experience to our patients.  Our admin staff take on the tasks of scheduling and rescheduling and resolving insurance road blocks, as well as contacting other physicians on the patients’ rosters for advice on adjusting certain medicines prior to the procedure, or advising us that it is safe to proceed.   If they weren’t as diligent as they are, then there would be patients arriving on procedure day who might be cancelled as no one advised them to adjust certain medicines, or they have active medical issues that cause me to holster my scope. 

And we have a crack medical team of RN’s and LPNs who carefully interview patients upon arrival to ensure that there are no safety barriers to proceeding.  More often than you might think, our staff discovers that the patient was recently in an emergency room for an issue that might alter the plans for a colonoscopy.  Similarly, our alert and trained staff might observe an abnormal heart rhythm on the monitor.  We might then advise that a visit with a cardiologist makes more sense than proceeding with a colonoscopy, You get the idea.

We work with highly trained nurse anesthetists who monitor patients continuously during the procedures.  They make a difficult job appear look much easier than it is.  And they serve as true guardians of safety by reviewing every chart a few weeks in advance to highlight and address any safety concerns.

And we have an RN and a technologist in the procedure room who work together to assure that all biopsy specimens are handled and labeled with care. 

This is not a ‘one man show’ at all.  There is a skilled team of professionals all of whom are necessary to bring about the desired outcome.  These folks don’t always get the recognition they deserve. They make doctors like me look good.  I appreciate all of them enormously and I do my best to make sure that they know it. 

So, if you find yourself wondering which doctor will be performing your procedure, you might want to rephrase the question. 

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox.