COLONOSCOPY ISSUES
GASTROENTEROLOGIST FROM PENNSYLVANIA
Physicians can be criticized and sued for problems that fall under the headings of errors of omission and commission. One of the more common problems that can be considered a problem of omission is a failure to diagnose colon cancer. Colonoscopy is credited with being, at least to a large extent, responsible for a greater than 40% reduction of colon cancer mortality. Although it is an excellent diagnostic tool, the best currently available, it is not perfect by any means. The major reduction of colon cancer and death attributable to early diagnosis, and polypectomy, primarily of distal lesions, those below the splenic flexure. Lesions in the ascending colon have not been proved to be as amenable to early diagnosis and therapy. This comes from a variety of reasons including the presence of flat or depressed lesions, positions behind hard to flatten folds and poor colonic preparation. In addition, the cecum may not have been reached. Protecting patients from disease and the physician from legal jeopardy is important and careful documentation of the extent of the exam, thoroughness of evaluation, withdrawal time and cleanliness of the bowel, need to be graded. Incomplete examinations, whether due to poor prep or technical problems need to be addressed with either a repeat exam in a timely fashion or CT colonography, if available. Also, good adherence to recommended follow-up intervals should be communicated to the patient and referring physician.
Another issue gastroenterologists’ face is complications from procedures, especially post colonoscopy perforation and bleeding. These are recognized problems and their mere occurrence doesn’t necessarily indicate negligence or poor technique. How the untoward event is managed is often more the problem. During the pre-procedure informed consent process, it is vital that patients know these events can occur, however unlikely they may be. The patient has to understand that prompt contact with the physician when any unusual symptom develops is indicated. Waiting to see if bleeding or pain subsides is not acceptable. Expeditious evaluation of the issue can mean the difference between a good outcome and a disaster. When a patient needs to be sent to an emergency room phone contact between the ER staff should precede the patient there and we can’t rely on the patient complaint alone. Although this seems self-evident it is surprising how often this doesn’t occur.
There are no ways to always avoid jeopardy but active engagement with the patient at all phases of care clearly minimizes risk.
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