Blog | Friday, March 16, 2018

Scoping out the reasons for overuse of colonoscopy


In our practice we have an open endoscopy system, as do most gastroenterologists. This means that other physicians or patients themselves can schedule a procedure with us without seeing us in advance for a consultation. Of course, we are always pleased to see any of these patients for an office visit in advance, but many patients prefer the convenience of accomplishing the mission in one stop. This is reasonable for patients who truly need our technical skill more than our medical advice.

Our office screens these procedure requests in advance to verify that no office visit is necessary. While this process works very well, it is not infallible. There have been times when a patient arrives to our office poised for a colonoscopy with accompanying medical issues more complex than we had expected.

No vetting procedure is failsafe. Have you seen the Transportation Security Administration statistics when they are tested in identifying dangerous items hidden in luggage? Even though our trained personnel vet the procedure candidates, no process can capture every issue. Also, sometimes patients forget about a medical condition or risk factor or medication, even when questioned about them.

In addition, there have been occasions when patients arrive prepared for an endoscopic intrusion into their alimentary canal, when the procedure may not be truly indicated. Keep in mind that the timing of a medical test often depends upon medical judgment. For example, capable gastroenterologists may have differing opinions on whether a colonoscopy for a particular patient makes sense.

Recently, a patient whom I had never met arrived for me to do a colonoscopy. He had enthusiastically swallowed the liquid dynamite, which had the desired cleansing effect. I presume he took a day off of work and had a driver with him. My review of his records demonstrated that he was about two years too soon for this procedure. The reason he scheduled the exam is because his prior gastroenterologist's office sent him a computer-generated letter that he was due for a colonic violation. In other words, the patient was following his doctor's advice.

I speculate that the reason that the computer issued a Notice to Appear was that the prior gastroenterologist experienced a “click malfunction” and clicked Return in 3 Years by error, rather than have correctly requested a Return in 5 Year recall. While this may sound egregious, ask your doctor how many screw ups he has committed on electronic medical record (EMR) systems. Indeed, EMR has created a new niche for medical malpractice attorneys to sue physicians and hospitals.

So, I have a patient before me who endured a night of purging, who has missed work and has a driver with him. But, he is 2 years early. What should I do?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.