Friday, November 4, 2011

Open Access Endoscopy. Is GI Following The Same Fateful Path As Anesthesiology?

An open access GI procedure is when an endoscopic procedure is performed on a patient without a full consultation with a gastroenterologist. Some have advocated this approach as benefiting patients by allowing faster scheduling of cases with less paperwork and hassle. In fact, Dr. Thomas Deas, Jr., M.D., president elect of the American Society for Gastrointestinal Endoscopy, has presented an informative article on how to increase open access procedures for GI docs. Some of the advice he gives include finding and working with the a good primary care doctor who you can trust to refer a low risk patient for an open access endoscopy. He says that virtually any healthy patient between the ages of 50 and 80 is eligible for open access. If a patient have chronic issues like diabetes or respiratory illnesses, then they should undergo a full consultation first before having the endoscopy.

Now why does this line of reasoning sound so familiar to anesthesiologists? Because that is the precise logic GI docs use to preclude anesthesiologists from providing sedation for endoscopic procedures. If a patient is relatively healthy, who needs a fully trained anesthesiologist? The gastroenterologists can give the sedation themselves or in the not too distant future, the patients can give their own propofol with the help of a self controlled pump. No anesthesiologist involved to delay a case, cancel a case, or take any money from their surgery centers.

But the GI guys better be careful what they wish for. Open access endoscopy on healthy patients can easily lead to competition from their fellow health care providers. By not doing a full consultation on a patient, the gastroenterologist has basically reduced himself to a scope monkey. Anybody can take a course in endoscopy and do a procedure on a healthy patient. It may not be as perfect as a regular GI doc's but for a screening procedure it should be good enough. With practice, the outcome might even be comparable. Therefore the internist or family practice doc may decide to pad his income by doing the endoscopy in his own office. Or perhaps in the future a nurse practitioner or physician assistant will take a course in endoscopy and do procedures for the internist in his office, bypassing the need for an expensive gastroenterologist to do the same thing. Healthy patients don't need the full expertise of a fully trained MD to watch over them right?

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