Here’s a scenario that I face fairly regularly in my endoscopy and colonoscopy practice. As readers know, over the past 5 or so years I have been employed in a rather well-known Cleveland-based health care institution. Prior to that, I was a private practitioner. During those earlier days, I personally knew most of our scope clientele as they were our patients. There was a minority of patients whom we did not know who were referred in by their doctors for routine scope exams. In contrast, in my current employed role, nearly all the scope patients on my schedule are meeting me for the first time. From time to time, a patient who is scheduled for a colonoscopy will call my office asking if an upper endoscopy can be performed at the same time because their heartburn or some other symptom has been active. Which of the following responses are most appropriate? Yes we will gladly add on the extra scope test to assess your stomach and esophagus as this would be an o...
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...