A recent JAMA article has ignited another storm of controversy over the use of anesthesiologists in routine colonoscopies. They found that the use of anesthesiologists in the GI suite has increased over the past few years, from 14% in 2003 to 30% in 2009, most of which go to "low risk" patients. The authors speculated that the reasons for this include quicker turnaround of cases with the use of propofol, patient preference, and most cynically, financial gain by the physicians. Skeptical Scalpel wrote in KevinMD that a likely reason for an expanding role of anesthesiologists in GI is because of medicolegal reasons, or cover your ass. If there is a complication with the sedation, such as an aspiration or cardiac arrest, it is more convenient for the gastroenterologist to blame somebody else if there is another MD in the room. It's harder to pin the blame on the nurse giving the Versed that he himself ordered given to the patient.
I'd say we have all forgotten another benefit of having anesthesiologists give the sedation for an endoscopy. Last year I mentioned a paper was presented at Digestive Disease Week, the largest GI conference in the country, that concluded colonoscopies were more effective if an anesthesiologist was giving propofol. More polyps were found when we were in charge of monitoring the patient. This only makes sense as the GI docs can concentrate their efforts on the actual scoping of the patient instead of worrying about the patient's vital signs, assuming they actually do pay attention. At the end of the day, isn't detecting more polyps the goal of giving routine colonoscopies to prevent colon cancer? In the long run, the use of anesthesiologists in GI will save insurance companies millions of dollars in preventable cancer treatments. But of course it is hard to put a number on a supposed future savings when these companies only count their quarterly profits.
So get the word out. We are not going to win the battle on patient safety when it comes to anesthesiologist monitored endoscopies. But if continue to spread the word that disease detection is greater with us present, then that will hit the skeptics where it counts, in their pocket books.
Interesting article, thanks for spending the time to assemble it. I like the direction you are taking your blog.ReplyDelete
I suggest you try "Medicine for Real" at wordpress. It's a blog by an anesthesiologist who has apparently drunk the kool-aid; i.e. how "expensive" colonoscopies are, and how routine anesthesia service is exploitative, how nurses giving sedation for GI docs is perfectly fine, etc. Happy reading!ReplyDelete
From a blog post by Dr. Shirie Leng, an "Anesthesiologist" who blogs at Mediciine for Real at wordpress. Leng was lamenting our "overinvolvement" in endoscopies: "Anesthesiologists are not in the patient safety business. Patient Safety officers are."ReplyDelete
Before we try to get the word out to the public, maybe we should work on winning the hearts and minds of our own kind.