Monday, July 18, 2011

No More Excuses

How did I miss this juicy nugget of information? A paper presented at Digestive Disease Week in May has finally put to rest the canard that anesthesiologists are not needed in an endoscopy suite. The study, conducted by Dr. Brooks Cash of the National Naval Medical Center in Bethesda, Md, looked at over four and a half million colonoscopies performed over a ten year period. Roughly one third of the colonoscopies were performed with an anesthesiologist present.

Dr. Cash's team found that when an anesthesiologist was present, the rate of detecting a colonic polyp was 37.7%. When no anesthesiologist was there, the detection rate was only 37%. While this may sound like a small difference, with such a large sample the difference was considered significant. Similar positive findings were found when accounting for sex and age differences. What's more, when an anesthesiologist was performing the sedation, the rate of detecting colon cancer within three years of the initial colonoscopy was significantly higher, 1.97% vs. 1.71%.

There you have it. Now there are no more legitimate excuses for not having an anesthesiologist performing the sedation in the endoscopy suite. Anesthesiologists increase the effectiveness of screening colonoscopies, leading to higher rates of early cancer detection thereby saving lives and MONEY for everybody involved. Previous studies have already shown that patients prefer to have a propofol anesthetic for their procedure. They will be more compliant with a screening colonoscopy if they knew how painless it can be with propofol. The patients will then refer all their acquaintances to do the same thing. This again leads to early colon cancer detection which will save even more lives and MONEY.

What about patient safety? GI docs will insist that no studies have found that sedation given by an endoscopist has led to any more complications than one given by an anesthesiologist. While that may be true it's like asking whether a Boeing 747 flown by one pilot is just as safe as having the plane also carry a co-pilot (I don't need to tell you who the real pilot in the endoscopy unit is). One pilot in the cockpit will almost assuredly take you to your destination safely, with all the autopilot and other safety measures present. But wouldn't you feel more comforted by knowing there are two pilots taking you on the journey?

So that leaves only one excuse left for why gastroenterologists don't want anesthesiologists in the room. Do I even need to repeat it? It all comes down to MONEY. They think we slow them down which decreases the number of procedures they can do in one day thus costing them MONEY. How shallow of some of these docs to think our careful evaluation of our patients for their ability to tolerate an anesthetic safely is an impediment to their business plans. That is very egocentric thinking. The big picture is that anesthesiologists are saving MONEY by helping the endoscopists detect early colon cancer. This saves the hospital, the insurance companies, and the government an enormous amount of MONEY in the long run. The patients are more grateful for their humane sedation and successful screening. And another productive member of our society will be able to continue to lead a normal life because we prevented him from getting cancer. Isn't that worth the few hundred dollars it costs to have an anesthesiologist present during an endoscopy? Heck ya!

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