In recent years, people past the age of 50 have been urged to get a colonoscopy, perhaps the best tool for early detection of colon cancer. Undoubted this new emphasis has saved lives.
But for the gastroenterologists performing this procedure, there are increasing demands that they worry could affect the quality of their work. There's a survey to back that up.
Pressured to increase volume
Researchers at Mount Sinai School of Medicine have found that 92 percent of more than 1,000 responding to a survey believed that pressures to increase the volume of colonoscopies adversely impacted how they performed their procedures, which could potentially affect the quality of colon cancer screening.
The findings, based on responses from members of the American Society for Gastrointestinal Endoscopy (ASGE), are published in the March 2012 issue of Gastrointestinal Endoscopy.
Dramatic increase in numbers
“The number of colonoscopies has risen dramatically over the past fifteen years, but it is imperative that an increase in volume not occur at the expense of quality and safety,” said Lawrence B. Cohen, MD, lead study author and an Associate Clinical Professor of Gastroenterology at Mount Sinai. “Balancing quantity and quality is an issue that needs to be addressed in order to ensure the continued success of colon cancer prevention programs.”
Overall, 92.3 percent of survey respondents indicated that production pressures, such as heightened demand for the procedure, rising overhead or shrinking reimbursement rates, resulted in physicians postponing, aborting or reducing the extent of a colonoscopy procedure.
For example, 7.2 percent of participants said production pressures made them reduce the time examining the colon wall, 5.3 percent of participants said these pressures made them abort a difficult colonoscopy, and 69 percent said they performed a colonoscopy on a patient with an unfavorable risk/benefit ratio.
A colonoscopy is used to look for early signs of cancer in the colon and rectum. It is also used to diagnose the causes of unexplained changes in bowel habits. Colonoscopy enables the physician to see inflamed tissue, abnormal growths, ulcers, and bleeding.
If a polyp, inflamed tissue, or anything else out of the ordinary turns up in the screening, the physician can remove all or part of it using tiny instruments passed through the scope. This allows the doctor to remove tissue from the colon wall that could eventually become a tumor.
While no one is debating the value of the procedure for patients at risk for colon cancer, some doctors are clearly worried they are not given enough time to examine each patient. Thirteen percent of respondents indicated that they have insufficient time for a pre-procedure assessment, 7.7 percent believed they routinely had inadequate time to complete an examination and 5.5 percent believed that patients were discharged from the unit prematurely. A majority, 77.8 percent, said they believed their caseload was excessive.