I'm going down to florida for a Laparoscopic course for a couple days. I figure, can't hurt to get a different perspective, see how other guys are doing lap colons. A couple of random notes.
1. Data starting to come back on CT Colonoscopies. Kevin MD links to this. It will be interesting to see the backlash from our esteemed GI colleagues. Dare I say, turnabout is fair play? A general surgeon who has the gall to perform EGD's or colonoscopies is demonized by his/her local medical community and effectively is frozen out of any future colon CA consults. Virtual colonoscopy can potentially eliminate the need for routine screeening scopes. Seems best for the patient, as long as the literature supports the safety of such practice. But that means thousands of scopes come off the billing dockets of gastroenterologists. Surgeons didn't complain (too much) when we lost endoscopy. Very interesting to see how this plays out.
2. I got a consult for small bowel obstruction this morning. I read through the chart and GI was consulted the previous day for "bowel obstruction". Guess what Dr. GI recommended? Surgical evaluation. I just don't get it.
3. Bob Woodward's series of books on Bush/Iraq are a must read.
4. Indians against the Yanks tonight. I have a good feeling. Sabathia and Carmona trump anything the Bombers can put on the mound.
5. Friday Night Lights is the best show on TV. Watch season one for free here.
Regards the GI note for surgical consult; what type of insurance did the patient have.
Regards virtual vs optical colonscopy, seems like another opportunity to increase healthcare costs. If I have a virtual colonoscopy and polyps are noted, if I want them removed I need to have another consult, have another procedure, which means another bowel prep and who knows what else.
Is this analogous to the non-interventional cardiologist-who does a cath, finds a lesion and then says, "yep, you've need an angioplsty with stents". We will reschedule you and put you through all of this again just as soon as we can!
in my setting, a gastro guy is a rare thing. as far as i am aware, there is not one single one in the province where i live, so us surgeons handle that stuff. one stop workshop. we scope, diagnose the cancer and then operate. i'll probably stand on someone's toes now, but i've always viewed a gastro guy as someone who secretly wanted to be a surgeon but didn't want to go through the paces.
sorry to all the respectable gastro guys out there.
Tom- Patient had fantastic insurance. As for virtual colonoscopy, I would certainly prefer a completely non-invasive screening test over a real colonoscopy, given that only 10-15% of people will have polyps. If If polyps are present, so be it; I'll get the real scope done.
Bongi- You wouldn't believe the prestige that GI guys have attained in this country. They are invariably the first person consulted on appendicitis, cholecystitis, pancreatitis, and a slew of other diagnoses that are more appropriately diagnosed and , more importantly, TREATED by a general surgeon. What a great life they have. Stenting and scoping and billing for all these things, and if trouble develops, well, just call the surgeon.
in our country you can become a gastro guy by either going through medicine or surgery. we therefore have surgical gastro guys. that must be the life. do the scoping and stenting and then actually treating things like appendicitis etc. actually there are not too many of them though.
Consulting gastro for bowel obstruction or appendicitis just seems silly to me. GI bleed, yeah. Bile duct stones, sure. Do you have some really lame internists and FPs who are not bothering to make their own (presumptive)diagnoses? "Oh-belly pain. call gastro to make dx!" If so I'm glad I live somewhere else.
Midwest- The ER calls the internist. The internist hears the word "abdominal pain" and automatically consults GI as part of the admossion phone orders. That's the world I live in.
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