Natural orifice transluminal endoscopic surgery

[spyyder]

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/20/AR2008092002384.html?referrer=digg

I found this quote interesting:

Cronin also worries that non-surgeons may start performing the procedures.

"If NOTES is being done by a gastroenterologist who does endoscopies, they may know what the anatomy looks like in a textbook, but they are very unsophisticated and unknowledgeable about what complications to expect from surgery and how to treat them because they are not surgeons," he said.

Protecting the turf early I see.

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[lemonade02]

i'm only an IM resident but i kind of agree with the surgeon...it just seems wrong

 

[spyyder]

I could be wrong, but GI already has an advanced endoscopy fellowship for those interested. If a doctor is comfortably doing the procedure they shouldn't have a problem. They could always create a new field of training like "interventional GI" kind of like cardiology did to quell any doubts.

 

[Taurus]

GI will have to look for something to replace colonoscopies as their main money-maker. Virtual colonoscopies are just around the corner.

CT scans can detect about 90% of the medium and large lesions and cancers detected by colonoscopy, a study in this week’s New England Journal of Medicine found.​

 

[lemonade02]

and yes, they're looking forward to being able to take weekend courses and buy scanners that cancel out everything but the gi tract and read the studies themselves..and at the same time having more colonoscopies to do as more people get screened with VC....you're right its going to be great!

 

[radslooking]

and yes, they're looking forward to being able to take weekend courses and buy scanners that cancel out everything but the gi tract and read the studies themselves..and at the same time having more colonoscopies to do as more people get screened with VC....you're right its going to be great!

are you telling me that radiology is going to get turned into radiological primary care....the specialists cherry picking the most remunerative studies and leaving the mammograms for the rads???

 

[Taurus]

and yes, they're looking forward to being able to take weekend courses and buy scanners that cancel out everything but the gi tract and read the studies themselves..and at the same time having more colonoscopies to do as more people get screened with VC....you're right its going to be great!

Here's a real case: a cards got sued because he canceled everything but the heart on a CTA and missed the lung cancer.

When you expose someone to that much radiation, you better be able to read the entire study or don't read it at all.

 

[GassiusClay]

Here's a real case: a cards got sued because he canceled everything but the heart on a CTA and missed the lung cancer.

When you expose someone to that much radiation, you better be able to read the entire study or don't read it at all.

I agree. Who knows what will happen once non-radiologists start reading stuff and then leave out the organs that they don't understand (or care about to a large degree from their practice perspective).

The problem is no one is going to read a film as good as a radiologist since they do it ALL the time. However, I am aware of many neurologists who don't really care what the CT Head impression is because they have seen so many now. The borders will remain blurry unless legislation or litigation have their say.

In the end, any over utilized procedure will be downgraded in the Medicare books EVEN colonoscopies. GI docs have it great now, but I can see it headed the way of cataracts as bureaucrats think its run of the mill procedure versus something special and unique. Once again, legislation will dictate it all.

Hopefully I can work with some decency until 45 or maybe 50, and then find another career.

 

[San_Juan_Sun]

Protecting the turf early I see.

Not protecting the turf, just the patient.

Truthfully, I'm not sure why gastroenterology as a specialty would want to get into NOTES (besides the $$$). It seems like the learning curve, the liability, difficulty getting privileges, the complications, and the general hassles would preclude all but the most motivated (dumb?) GI guys from practicing NOTES. It's not like you guys aren't busy doing plenty of challenging, worthwhile procedures.

 

[spyyder]

Here's a real case: a cards got sued because he canceled everything but the heart on a CTA and missed the lung cancer.

When you expose someone to that much radiation, you better be able to read the entire study or don't read it at all.

I don't get this mentality. When a patient visits a Radiologist to get a scan, do you also expect them to diagnose skin lesions, when that might be better suited for a dermatologist. When a patient who might have bipolar disorder visits a surgeon do you expect them to diagnose personality disorders instead of referring to a psychiatrist?

Why can't cards or GI stick to their core competencies? You guys say you are looking out for the patient, but all you are doing is protecting your turf. Healthcare costs are out of control because specialists want to monopolize procedures. Isn't ironic that the fields most desperate to protect procedures (Radiology, Anesthes, Surg Sub-specialties) are also the highest paid fields.

 

[Taurus]

Why can't cards or GI stick to their core competencies? You guys say you are looking out for the patient, but all you are doing is protecting your turf.

If you haven't realized it yet, medicine is one big turf battle. Every single field of medicine has competition from either other medical specialties or midlevel groups like NP's and CRNA's.

But let's say I agree with you that we should stick with our core competencies, isn't imaging the core competency of radiology and therefore what business does GI have in trying to do image interpretation, even if it is of the colon? Things aren't so black and white.

 

[DarkProtonics]

If you haven't realized it yet, medicine is one big turf battle. Every single field of medicine has competition from either other medical specialties or midlevel groups like NP's and CRNA's.

But let's say I agree with you that we should stick with our core competencies, isn't imaging the core competency of radiology and therefore what business does GI have in trying to do image interpretation, even if it is of the colon? Things aren't so black and white.

My perfect world is this: abolish NPs and CRNAs, replacing them w/ PAs and AAs. Also make a requirement for JACHO certification that all final imaging reports must be signed off by a US board-certified radiologist in that specialty; ie cardiology and GI must have their angiograms and colonoscopies interpreted by cardiovascular and gastrointestinal radiologists, respectively.

Why do we have NPs when we have superior PAs?

 

[rouleaux82]

If if you have any interest in NOTES, please get the facts:

1. Internal medicine and it's subspecialities have been becoming more and more invasive...to say that "this is not our area" or "I think the surgeon is right" is to have a poor understanding of where GI (and even cardiology) is heading.

2. For surgeons to have CONCERNS about gastroenterologist's knowledge about the abdominal anatomy is founded. BUT I have concerns with a surgeons ability to handle a scope considering the current training paradigm for surgery residents have almost ZERO focus on endoscopy.

3. It is incredibly FRUSTRATING to see these news articles with general surgeons blabbing on and on about THEIR remarkable accomplishments (well I agree it is remarkable). First off, it was a gastroenterologist who developed the concept (Kalloo at JHU). Secondly, if anyone actually reads the white paper-NOSCAR guidelines, it CLEARLY says that the initialy evaluation of these procedures should be a JOINT effort with both surg and GI. What people don't understand is that the line between a GI and surgeon is blurring...it will be a hybrid profession. With surgeons forming fellowships to learn advanced endoscopy, with GI forming fellowships to acquire the basic skills of surgery.

4. GI is changing. CT-colonoscopy is going to be perfected, deal with it. Pt's WILL go for it. The type of patients that GI will see will change; less screening, more biopsy driven (thus increasing the rate of complications). The future of GI will suffer if people within the field remain CLOSE MINDED....it is up to medicine residents, GI fellows and GI attendings to research and be leaders in the field of BOTH endoluminal and transluminal surgery.

5. Why does every topic eventually digress into an argument about radiology vs. X-speciality? I swear radiology residents troll the forums to confront anyone who hints at the idea that non-rads should have to opportunity to read images. I don't really care either way.

Thanks for posting the Wash Post article....