Colonoscopy Practices & Perceptions Among Endoscopists

Previous research has shown that fatigue is an under­estimated cause of underperformance among physicians. The issue of production pressure and its effect on quality of care permeates every aspect of the healthcare industry, including colonoscopy. Studies suggest that fatigue or other byproducts of production pressure may negatively influence the quality of colonoscopy, which could affect the quality of colon cancer screening. Surveying the Endoscopy Scene In a recent issue of Gastrointestinal Endoscopy, my colleagues and I published the results of a 40-question online survey designed to assess the perceptions of practicing endoscopists regarding production pressure and its effects on their personal performance of colonoscopy. According to our results, 92% of respondents indicated that production pressure influenced one or more aspects of their endoscopic practices. Examples of production pressure included: Proceeding with colonoscopy in patients with unfavorable risk/benefit ratios. Reducing the length of time spent inspecting the colon. Postponing polypectomy for a subsequent session. Our study also found that almost half (48%) of respondents  witnessed the effects of production pressure on a colleague. Respondents working fee-for-service and those with more than 10 years since completing their fellowship were more likely to describe their weekly workloads as “excessive” when compared with those who were salaried or less than 10 years out of training. Our survey also showed that many respondents don’t have enough time for pre-procedural assessment, and some believed that patients were discharged from their unit prematurely. About two of every five respondents (42%) identified one or more sources of inefficiency within their practice, such as an inadequate number of procedure rooms, insufficient staff, or too few beds in the...