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Is an Open-Access Policy the Best Choice for Endoscopic Procedures?

Lawrence M. Pickover, MD
Arch Intern Med. 1997;157(8):924. doi:10.1001/archinte.1997.00440290110013.
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The article by Mahajan and colleagues1 describes an open-access policy for colonoscopy where, on the average, 15% of procedures (for primary care physicians) and 33% of procedures (for non—primary care physicians) were performed for inappropriate indications. That the procedures performed were not indicated was known by the endoscopist before the procedure. How can physicians defend themselves if a procedure, which is not indicated, leads to a complication? On the other hand, I would hate to face the wrath of patients who had their colonoscopies cancelled after taking 2 days off from work and drinking a full colonoscopy preparation. The only answer is for patients to consult with the endoscopist before the procedure. This gives the endoscopist a chance to discuss the risks of the procedure, obtain informed consent, advise the patient about medications (no aspirin 1 week before the procedure), and, when needed, discuss the advantages and disadvantages of antibiotics


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