Interesting NYtimes piece on colonscopies and their overuse.

Not surprising 0_o !

Thanks for posting this, AZY. The issue really has become the anesthesiology requirement, which I find totally outrageous, and this article agrees. I don't object to my gastro's fees-- as this doctor is a very fine experienced endoscopist who would never pump patients full of unneeded air during the procedure. But I'm furious with the medical center where gastro is obliged to do c-scopes now, with review of patient chart by anesthesiologist before procedure + administration of IV-Propofol during procedure by nurse-anesthetist-- who then both submit bills over $1,000 each for their services. (Luckily, my insurer forces much lower payment.) We owe this anesthesiology outrage in large part to a dingbat researcher at Yale Medical School, who published a study in late 1990s, I think, claiming that gastros find more potential malignancies during c-scopes if they don't have to administer/monitor the patient's sedation themselves! What baloney ... A well-trained endoscopist will find real problems regardless of whether or not an anesthesiologist takes part at the scoping!!!!! / Old Hat (32 yrs with left-sided UC; presently in remission taking brandname Colazal)

AZYooper said...
www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?smid=pl-share

I think it is very interesting that nobody has ever show the colonscopy is a superior test to flex/sigs or even occult blood test for cancer detection. Average GI salary is

Yes, but a lot of the $ that is paid out isn't seen by the dr. There was part of the article that was talking about how a GI doctor was not able to tell the cost, total cost of a scope. You'd think he'd know the numbers.

& yes my sister is doing her residency at Cornell to be a pediatric GI doctor and it's the highest paying type of dr. WHY? Because we live in a sick nation thats not getting better and also a big contributing factor to the high salary is high traffic rates per se. At the Mayo Clinic while I was having a scope, there were 14 other scopes being performed. Then they wonder why instruments get left in patients (this happens A LOT...YES... medical happen more than you would think. read about and it's shocking)

Scopes are necessary... absolutely, but there should be a minimum time allotted to perform one so accidents of missing something doesn't happen because the dr. is rushing. Also put a camera in each room. It is proven that if someone knows they are being watched/recorded, error rate falls significantly. These procedures can kill people and they stuff patients in for screenings like hot cakes. Quality doesn't seem so priority. That's why the GI industry is the highest paying field of medicine. The costs are ridiculous & the quantity of screenings (& digestive diseases... in the young population is rising) is super high.

My current Has a regular office and owns and operates the out patient center that does colon scopes , when he is not out traveling the world with his lovely wife! He makes millions, litteraly!

A forum member posted here 2-3 yrs back that he was literally saved by c-scope because it turned up a malignant polyp in his ascending colon, an area likely to metastasize to the liver. He was in remission on maintenance med for a good while when this happened. So there ARE cases when colonoscopy finds problems that would otherwise not be detected in time for successful intervention. / Old Hat (32 yrs with left-sided UC; presently in remission taking brandname Colazal)

I agree, Seconder. And don't forget-- some docs have been pushing the so-called "virtual" colonoscopy, especially at top executive-types who want to be sure their annual physical covers everything from head-to-toe, U.S. President among them. / Old Hat (32 yrs with left-sided UC; presently in remission taking brandname Colazal)

Sweets7 said...
i read this last week... Well it's because the US charges more for everything other countries get at reasonable prices. I liked the authors example.. like the $100.00 ice pack after Physical Therapy.. It's water in a plastic bag!! The US of F'ing A's.. gotta love the way they run things.

That article totally had me wanting to get out of here even quicker than I had planned. I'm so done here it's not even funny. I'm disgusted with the US and have had enough!

Wow, your bitterness is through roof. Probably, even a North Korean does not hate the US so much.

That being said, I am not US citizen either but have lived in few countries on the top of this world. Every country has its pros and cons. You have to decide what you can live with. Its absolutely fine if you do not like the US system but the bitterness is little too much.

I agree with some of points that the author raises but I think she should have done a little more research. Arguing on these points is certainly way out of the scope of this post but just a couple of points,
- Ice pack used in physical therapy is NOT same as water in plastic bag. There are literally 100s of types of ice packs (I have 5 types in the freezer right now). So if you would like to use frozen water, feel free but do not sue therapist if something goes wrong.
- Some blame goes to the patients as well. Why do you need anesthesia for sigmoidoscopy? Many of the americans do not stand a little pain and the invention of pain scale is most stupid invention ever. I do my sigmoidoscopies without anesthesia (have done more than 30 so far) and that reduces my bill to half (plus, I get to see how the heck it looks inside so that I aware of inflammation inside)
- Rise of money sucking lawyers. Ever wondered about the advertisements on the TV, got this, you could be entitled for money, billions of dollars are set aside for that and blah blah. This all compounds to higher malpractice insurance costs.
- Big hands in insurance systems. They make boat load of money. This is worst system I have ever seen and the US seriously needs to scrap this system. Probably, this is the only developed nation that uses such system.
- For the drugs, there is average wholesale price calculated by some body and this price is way too high. As I mentioned a few times here, my friend has a pharmacy and we talk a lot about these issues. He mentioned, if he could get 30% of this price, he will make enough profit but insurance companies and other regulatory bodies make it hard for him to do that so he can not do it for masses otherwise he will be sued. (Because I asked him, if he could set up a system for this forum where those folks with craptastic or no insurance can benefit and he gets a business.)

No, medical arena is not saint at all and I hate them just as much you do but other sections of the society do not get to go without any blame.

Having read the NY TImes article, I am horrified at the prices of the US colonoscopies. I live in a southern European country with a good healthcare system. I do not have medical insurance and I am not a citizen here so I could not use the public healthcare system and so I had to take the private clinic route. I have found a great GI who I am comfortable with (but struggle with English with the other staff at the clinic). I recently had a sigmoidoscopy which cost me $80. Today I had a colonoscopy which cost $123 but had I opted for anaesthesia that would have risen to $442. There has been a marked rise in medical tourism here and I guess now I know why. I thought my Rx drugs were expensive here but perhaps those are comparatively cheap too.

Wow. As an English person I've always been intrigued by how much you Americans seem to go for colonoscopies. People with UC in England will usually get scoped once at diagnosis and then wait 8 years until their next scope since the risk of colon cancer is said to be no higher for us than for the general population until we've had the condition a long while. I think after that we get them once every two years.

Of course I'll have a quick flexi (without sedation) to aid drug decisions every so often.

I will never again have a flex sig without sedation...that was one of the most painful experiences of my life (it was while flaring). I'm all for the sedation, no matter what type of scope it is. I do agree the prices are outrageous though.