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Thursday, November 15, 2007

Who Should Do Your Colonoscopy?

Who Should Do Your Colonoscopy?

Note:While the information contained in The Colonoscopy Chronicles will be as accurate as possible, it is not intended as medical advice. You should consult your personal physician regarding your own medical issues.

Like most boomers-you want to research your procedure in advance. Logically, your first question may be:Who should do the procedure? In short, I would recommend a board-certified Gastroenterologist. This may seem like a bit of a “no-brainer”. After all, aren’t all colonoscopies performed by Gastroenterologists? No! We’ll talk later about what other physicians do colonoscopy.

The vast majority of colonoscopies in the United States are performed by Gastroenterologists. A Gastroenterologist is a physician specifically trained in the field of digestive diseases. The training generally consists of a four-year college program, followed by a four-year medical school, then a three year internship/residency in Internal Medicine, and finally a fellowship in Gastroenterology-usually for three years. During this fellowship, trainees learn in depth about digestive disorders, and also learn to perform endoscopic procedures-including colonoscopy.

Most physicians who complete their training in Gastroenterology become board-certified under the auspices of the American Board of Internal Medicine. Board certification in Gastroenterology means the physician has 1)completed an accredited training program in Internal Medicine, then passed the Internal Medicine Board Exam 2)completed an accredited training program in Gastroenterology, then passed the Gastroenterology Board Exam.



If colonoscopy is not performed by a Gastroenterologists, it would most likely be done by a surgeon or primary care physician-such as an Internist or Family Medicine specialist. It is relatively uncommon for primary care physicians to perform colonoscopy, but in some parts of the country that are underserved by Gastroenterologists, primary care physicians have learned to do the procedure out of necessity.


· Is it necessary for your physician to be a Gastroenterologist in order to perform your colonoscopy?
o No-but studies have shown that colonoscopies performed by non-gastroenterologists are five times more likely to miss colorectal cancer.

· Is it necessary for your Gastroenterologist to be Board Certified?
o No-but it indicates that they have met certain well accepted standards of training.


Comment: Gastroenterologists are generally your best bet-they have generally have the most extensive training and experience with colonoscopy. There are certainly many surgeons and primary care physicians who are well-trained, and highly competent.

I liken it to pitchers in major league baseball. They are generally all amazing athletes, and most of them were well-training in batting at one time, and most were excellent hitters in high school, or even college. However, since they specialize in pitching, they don’t have as many at bats as the position players, and don’t have as much time to take batting practice. Therefore, they generally are not as good hitters as the position players.

Make sure the physician performing your colonoscopy does them frequently. Most Gastroenterologists have performed thousands of colonoscopies. Make sure that their success rates and complication rates meet certain standards.
The success rate(measured by the frequency with which the physician is able to examine the entire colon) should be over 90%. It should be even higher(over 95%) for screening colonoscopies.
The physician’s track record for complications is another measure of competence. The rate of perforation should be lower than 1 in 500 cases-many experts have rates less than 1 in 1000.

Next….Where should you have your colonoscopy?

4 comments:

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Jonson Brottun said...

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