Blog | Thursday, July 18, 2019

Why patients avoid colonoscopies, a plea to choose wisely

Exercising good judgement can mean the difference between life or death. Life can be unforgiving of the choices me make. As we all know, many life events are beyond our control and understanding. But, there is much we can do to shape our personal paths to a brighter destination.

Consider some of the choices listed below that many folks make every day. Are any of them familiar to you?
• Texting while driving.
• Riding a motorcycle.
• Riding a motorcycle without a helmet.
• Lifting an object that we know is too heavy for us.
• Getting into a car when the driver has had one too many.
• Driving a car when we have had one too many.
• Giving your social security number to a caller who is promising you a tax refund.
• Responding to an email from Nigeria alerting you to a wad of cash waiting for you.
• Using your date of birth as your password for your on-line bank accounts.
• Rushing through a yellow light so we won't be late for a movie.
• Eating street food in a foreign country that appears undercooked.
• Skipping a ‘flu shot’ and other recommended vaccines.
• Getting chest pain for the first time after shoveling snow and decided it was just heartburn.

Get the point?

All of the above activities can end tragically depending upon the choices we make. But, they can easily end well for us. Every day, we confront forks in the road when we must make choices. Sometimes, we choose the wrong road. Sometimes, we make no choice at all. The point here is that we have a choice.

I see this issue in my gastroenterology practice. I've done about 30,000 colonoscopies in my career, a number so large, that I can barely believe it myself. Fortunately, the results of nearly all of them are normal or show benign findings. Telling a patient and their family that all is well after the procedure is a pleasure that hasn't changed over the years.

But, not every colonoscopy result is innocent. As you might imagine, I have confronted a lot of colon cancer in my career. When I discover one, I am aware that life for that person and his loved ones is about change profoundly. Life changes in an instant.

While colon cancer affects the patient and his family most deeply, it's a heavy day for the gastroenterologist also. We are human beings. What makes the day even darker for us is when the patient had faced a fork in the road, but made the wrong choice. Consider the following examples which I have seen repeatedly in my practice.
• A patient turns 50 but chooses not to have a colonoscopy, against the advice of his doctor.
• A patient has rectal bleeding and ignores it.
• A patient was told of hemorrhoids years ago. Rectal bleeding develops and he assumes that his hemorrhoids are active again. He does not consult his physician.
• A patient's bowel changes, but he decides that this must be a side-effect of new medication.
• A patient has a large colon polyp removed by his gastroenterologist. He is advised to return in a year for another colonoscopy, but he does not do so. He is too busy.

Colon cancer, unlike so many other cancers, is a preventable disease. I am not suggesting that modern medicine can prevent every case of colon cancer. It can't. I am stating that the majority of colon cancers that I have discovered were in people who did not choose wisely when they should have. They ignored. They denied. They delayed.

Time after time, I have seen intelligent people who have had rectal bleeding for months before they decided to see me.

Every expert will attest that the earlier colon cancer is diagnosed, the better the prognosis will be. But more importantly, timely colonoscopy can prevent the disease altogether.

I haven't made perfect choices at every fork in the road that I've faced. But, when I turned 50, I did the right thing.

We can't control everything. But, there is much that we can control. For example, you have chosen to read this post. How you decide to use it is your choice.

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.