Health News Review

On WBUR Boston’s Healthcare $avvy: The Health Care Consumer Experience website, Martha Bebinger is determined to be more informed before she goes in for her second colonoscopy (the other one was 10 or so years ago).  So she’s posted a list of questions she wants answered and she’s asking for suggestions for amendments to the list. Here it is so far:

1)     About the prep – what will give me the best cleaning out with the least discomfort?  There’s no point in going through all this if the doc can’t see what s/he is doing.

2)     What’s the doctor’s detection rate?  One medical society (the American Society for Gastrointestinal Endoscopy) says a doctor should find a polyp in 25% of men and 15% of women (why the difference?), but I know that some physician groups around Boston say the average is 40-50% among docs who really look for polyps.

3)     How much time does the doctor spend, on average, on the test?  I think more is better, is that right?

4)     Does the doctor always get to the end of the colon? OK, I may not be able to ask this.  One website says I should ask the doctor to take a picture so that I know they got to the end – but this is too gross and how would I know what to look for anyway?

5)    How many colonoscopies does the doc do each year?  The avg., according to the ASGE, is 750.  Again, more is better.

6)    What’s the doc’s error or complication rate per 1,000 patients.  I do not want to see blood afterward, although if the doc finds and snips a polyp, I suppose I will.

7)    One site says I should ask about the procedures for disinfecting equipment.  Really? Isn’t flawless disinfection standard procedure?

8)  And finally, I’ll ask how much each doc charges.  I’m supposed to be looking for the best test at the best price.

Of course, a more basic shared decision-making question is:  why colonoscopy instead of one of the other methods of colon cancer screening? 

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Comments

Greg Pawelski posted on November 30, 2012 at 3:38 pm

Also ask about the “Dose-Response Study of Fospropofol Disodium for Moderate Sedation During Colonoscopy.” That adds to the doctor charges. Is it really better to be put asleep?

http://www.medscape.com/viewarticle/571756

Justin Coleman posted on November 30, 2012 at 7:29 pm

Interesting article, thanks Gary. However, the first question before undergoing any screening test is ‘Do I need it?’ Bebinger does not give us enough information to answer to this, but the reason it always ranks as Question 1 is that if the answer is ‘no’, you save yourself the bother of asking the other eight questions!

David Hanson posted on December 3, 2012 at 9:49 am

The question is bigger than asking about using other methods — how about asking if colon cancer/polyps screening is needed/desired at all. The risk to an average person with no symptoms (not anemic and no visible blood in stool for example) is very low. The number of lives actually saved is very low — some will die of colon cancer even with the screening, some cancers/polyps will be missed, many of polyps will not become cancers that kill the person, some with colon cancer will die of something else, some of the polyps will disappear with time, some will be harmed (bowel perforation, death) by the screening….and other factors. All these should be considered.