August 3rd, 2011 by Michael Kirsch, M.D. in Opinion, Research
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Most of us born several decades ago, recall the futuristic book Fantastic Voyage by Isaac Asimov, where a miniaturized crew traveled through a human body to cure a scientist who has a blot clot lodged in his brain. Ironically, miniaturized medical care is now upon us while books are at risk of becoming obsolete.
I hope that gastroenterologists won’t become obsolete, at least until my last kid graduates from college.
I perform an amazing diagnostic procedure called wireless capsule endoscopy (WCE), when patients swallow a camera. Once swallowed, this miniaturized camera takes its own fantastic voyage through the alimentary canal. The test is used primarily to identify sources of internal bleeding within the 20 feet of small intestine, which are beyond the reach of gastroenterologists’ conventional scopes. I have performed over 200 of these examinations, and I am still awestruck when I watch a ‘movie’ of someone’s guts. While most examinations do not reveal significant findings, I have seen dramatic lesions that were bleeding before my eyes. WCE can crack a cold medical case wide open.
Here’s a typical view of the small bowel as seen by the cruising camera: Read more »
*This blog post was originally published at MD Whistleblower*
June 13th, 2011 by Davis Liu, M.D. in True Stories
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Dr. Mehmet Oz recently had a piece in Time titled “What I Learned from My Cancer Scare” in which he became the the more humbled Mr. Mehmet Oz. As noted previously here, Dr. Oz last summer had a colonoscopy at age 50 and much to everyone’s surprise had a precancerous colon polyp. He was advised to follow-up again for a repeat test in 3 months.
As the Time magazine piece noted, he didn’t return for 9 months despite repeated reminders from his doctor.
From this experience, he essentially stumbled upon what has been challenging American medicine and primary care. How do we enable patients to do the right thing and get the screening tests done and treatments necessary to avoid premature death and maintain a high quality of life? As a highly trained professional, Dr. Oz knows the risks and benefits of not doing a preventive screening test. As a doctor, he knows all of the secret protocols and codespeak we use when calling patients or asking them to see us in the office for important matters. As a doctor, he also understood the importance of a repeat colonoscopy to ensure no more colon growths.
Yet he didn’t return for 9 months. Why? Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
May 24th, 2011 by M. Brian Fennerty, M.D. in Health Tips
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I have noticed that we all think we are the best endoscopist around (in my case, that is indeed true!). However, we really never measured colonoscopy skill as a “patient-centered” metric and instead often use speed, efficiency, sedation needs, etc. when judging our colleagues. What is more important than these measures, however, is whether we find and remove adenomas, thereby preventing colon cancer downstream in our patients.
A number of surrogate markers for quality colonoscopy and polyp detection have been used in the past, including scope-withdrawal time from the cecum. But the one measure that has been the best predictor of quality is an endoscopist’s ADR (adenoma detection rate). In fact, this is the most reliable quality measure yet determined, and it may become the basis for being paid for these procedures in the not so distant future.
So I need to ask you:
1) Do you know your ADR?
2) Do you or does your group compare your ADR to other endoscopists within your endoscopy unit or practice?
3) Is there a program to increase ADR in low performers in your endoscopy unit?
4) Do you use your ADR as a marketing tool?
5) What is your take on the ADR as a quality measure?
I look forward to hearing from you on this topic!
*This blog post was originally published at Gut Check on Gastroenterology*
May 13th, 2011 by RyanDuBosar in News, Research
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Much more practice is needed than gastroenterological professional societies currently recommend, concluded Mayo Clinic researchers in Rochester, Minn.
Current recommendations are that 140 procedures should be done before attempting to assess competency, but with no set recommendations on how to assess it, wrote the author of the research. But it takes an average of 275 procedures for a gastroenterology fellow to reach minimal cognitive and motor competency.
Now, the American Society for Gastrointestinal Endoscopy is rewriting its colonoscopy training guidelines to reflect the need for more procedures and emphasize the use of objective, measurable tests in assessing the competency of trainees. Read more »
*This blog post was originally published at ACP Internist*
April 21st, 2011 by RamonaBatesMD in Health Tips, True Stories
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My husband had a screening colonoscopy last Friday. His nurse in the recovery is the only one I had issues with. I, not my husband.
All went well, but let me tell you he is not an ePatient Dave. He did not read his instructions about when to quit eating and the prep. I did. I then reminded him along the way: “Only clear liquids today.” “You must take the Ducolax at 3 pm. Do you want me to text you a reminder?”
Sometimes the instructions we give patients are clear, but not always read.
The staff at the front desk were very kind and organized. Calls had been made the day before and I had insured the insurance information they had was correct. I did not tell anyone I was a doctor. I’m not sure if my husband did later or not.
…..
When I was called back by the nurse, she mispronounced my name calling me Rhonda (which I forgave easily). She did not introduce herself to me.
As we entered the recovery area, she did not take me to my husband and assure me he was okay. She took me to the desk and abruptly said, “You need to sign this.” Read more »
*This blog post was originally published at Suture for a Living*
