The endoscopy room, gastroenterology department, Dunedin
Hospital, where endoscopies, colonoscopies etc are
performed. Photo by Linda Robertson.
Gil Barbezat argues that the debate over colonoscopies
in Dunedin has been distracted by a flawed survey and a
selective look at available and relevant statistics.
The colonoscopy saga aired liberally in the press
over the past few months has also brought to light a
long-standing dilemma of how to use tightly allocated
resources in the most cost effective way.
The general practitioner initiated so-called survey of
patients does disservice to the word survey.
It was a collection of selected anecdotal reports of
patients, not all of whom had passed through the Dunedin
Gastroenterology Department, over a period of many years.
A number (10 of 33) did not have a confirmed cancer
diagnosis.
To be fair, any proper survey needs to include a randomly
selected group, including the good and the bad.
Knowing how many patients were considered for inclusion and
over precisely what period of time is a basic requirement for
a meaningful survey.
Agreed, some of those reported had an unacceptably slow
progress through the system, but there are many possible
reasons for that.
Audit of problem cases is a valuable exercise, yielding most
benefit when reported promptly, case by case.
Delayed analysis aired through the press often introduces
distracting factors.
Most people are aware of the fact that colorectal cancer
(CRC) is common in New Zealand.
Colonoscopy is still the gold standard in its investigation
and diagnosis.
However, symptoms of CRC are usually very non-specific, and
include change in bowel habit, bleeding from the bowel,
abdominal pain and weight loss.
It is neither feasible nor necessary to investigate everyone
among the many hundreds in the population with any of these
symptoms.
In a situation of resource constraint, patients have to be
prioritised as to whether they will have a colonoscopy or
not.
Great care is required to choose those who are most likely to
benefit from the procedure.
In Otago, the colonoscopy review panel, made up of of
gastroenterologists and surgeons, makes this decision.
Besides the above symptoms, the panel also considers the
patient's age, family and past history, as well as other
possible individual factors.
Despite all this information, the process is not perfect,
bearing in mind that many patients with CRC do not have
typical, or any, symptoms until very late in the disease.
Resources for Gastroenterology at Dunedin Hospital have been
stretched for at least 25 years.
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