tag:blogger.com,1999:blog-4968787219619380438.post8246296555311138054..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Anesthesia fees for routine endoscopy/colonoscopy are expensive and may be unnecessary. Why are anesthesiologists used?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-4968787219619380438.post-48241525976500567922012-09-05T07:39:12.174-04:002012-09-05T07:39:12.174-04:00I agree there's not much choice in this electi...I agree there's not much choice in this election as far as medicine in concerned. I've made the decision to get out of the business and write about it from the sidelines.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-63716597035349047802012-09-05T00:23:12.569-04:002012-09-05T00:23:12.569-04:00I was always taught to (1) be safe and (2) be comp...I was always taught to (1) be safe and (2) be competent, and (3) ask for help if you need it.<br /><br />I can't tell you how helpful an anesthesiologist can be in an endoscopy procedure!<br /><br />I'd suggest EVERY single HMO/PPO/Medicare administrator have a colonoscopy, without ANY anesthesia (that's the chepest and safest. . .pain doesn't really HARM you...does it?) and then let them print this crap.<br /><br />I hate what medicine has become.<br /><br />Are you going to vote Democrat or Republican? I realized, today, after some introspection, that NEITHER god-damn party has helped medicine. NEITHER ONE.<br /><br />Come to think of it, let's scope the entire legislative branch of congress...no sedation...no anesthesiologist. . just a nice, easy, colonoscopy--you know...what they do to us every day--regardless of your party affiliation!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-51027310912689236142012-03-25T19:31:57.730-04:002012-03-25T19:31:57.730-04:00Waking Up Costs,
Thanks for the comments. Good po...Waking Up Costs,<br /><br />Thanks for the comments. Good points.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-51163518633527799622012-03-25T18:55:58.446-04:002012-03-25T18:55:58.446-04:00None of the outpatient endoscopy centers in my are...None of the outpatient endoscopy centers in my area use anesthesiologists. They all use CRNA's. The simple fact is that a center's 'throughput' is much greater with propofol anesthetics than it would be with versed/fentanyl. i.e. it's more profitable for the center to have anesthetists there.<br /><br />In our hospitals, it's not the anesthesiologists who are pushing to go to endoscopy. It's the endoscopists who are demanding our services.<br /><br />Finally, the idea that giving sedation is " SO straightforward" misses the fact that someone who is administering any manner of sedation must be able to rescue form the next deepest level should there be an overshoot. If someone is getting 'unconscious sedation', that person administering it should be able to rescue from general anesthesia.<br /><br />So, in my mind, it's not about money or cya or cy turf for anesthesiologists--but it may be for others.Waking Up Costshttp://www.wakingupcosts.net/noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-46675205457704080402012-03-25T15:21:58.603-04:002012-03-25T15:21:58.603-04:00Yes!!!! Robert.39!
-SCRNYes!!!! Robert.39!<br /><br />-SCRNAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9637446364185821132012-03-24T07:43:19.636-04:002012-03-24T07:43:19.636-04:00Anonymous and RobertL39
Good points. Thanks.Anonymous and RobertL39<br /><br />Good points. Thanks.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85513531104245020572012-03-23T20:48:23.920-04:002012-03-23T20:48:23.920-04:00Do general surgeons and gastroenterologists learn ...Do general surgeons and gastroenterologists learn sedation in residency? Yes, I know, it's not hard to learn if they want to. If they don't learn it in residency, it's about time they did. It's SO straightforward. And who do you suppose writes the often onerous qualifications for being to be able to give 'conscious sedation'? Did you say anesthesiologists? YUP. Instead of CYA it's "cover your turf". <br />As an added comment on Josh's remark, anesthesiologists apparently have come to believe that propofol is an anxiolytic. IT'S NOT!!!! Yeah, they go to sleep and stop breathing [so they're 'sedated'] but they wake up quickly and sometimes anxious, just like they were before the procedure. Anesthesia needs to remember the difference between sedation and anxiolysis. Anxiolysis makes happier patients! I have noticed that this problem is getting worse and worse. Some even refer to midazolam as 'antique'! Get with it, guys!RobertL39noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-68224912661515767252012-03-23T16:04:11.349-04:002012-03-23T16:04:11.349-04:00As a nurse who has worked in a small rural hospita...As a nurse who has worked in a small rural hospital for years and assisted with 100s of scopes...Let me tell you...You won't be doing my scope unless you have a CRNA pushing the drugs. I value my safety as well as my comfort. Our CRNA is fabulous and our patient satifaction rate is above tops.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-70443865601614267162012-03-23T07:54:34.390-04:002012-03-23T07:54:34.390-04:00I think its necessary for the patients to examined...I think its necessary for the patients to examined routine wise.Doctorshttp://www.medi4.comnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-330560512457272292012-03-23T07:43:19.579-04:002012-03-23T07:43:19.579-04:00Thanks to all for the interesting comments. It is ...Thanks to all for the interesting comments. It is a good topic for discussion.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-42080218093738437402012-03-22T19:48:39.452-04:002012-03-22T19:48:39.452-04:00This must be a difference between Canadian and Ame...This must be a difference between Canadian and American practice (likely resulting from the vast difference in litigation between the two countries), as virtually every endoscopy/colonoscopy at our local hospitals is done under endoscopist-administered sedation. With properly administered fentanyl and midazolam, most of the patients have little to no memory of the procedure and are relatively calm throughout.Solitary Diner (Also Known as The Frugalish Physician)https://www.blogger.com/profile/01239189582752445700noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-57977895974356939522012-03-22T16:19:04.027-04:002012-03-22T16:19:04.027-04:00I haven't read the article, but have noticed a...I haven't read the article, but have noticed a similar trend where I am. It relates to the use of propofol for scopes. The endoscopists prefer propofol because the patients go to sleep faster, stay sedated better, and wake up and go home faster. I suppose they don't feel as comfortable with propofol dosing and administration, though they could easily learn. That's just what I've seen.Joshnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-24990874467585053522012-03-22T15:57:46.294-04:002012-03-22T15:57:46.294-04:00My husband had a scope done via the Veteran's ...My husband had a scope done via the Veteran's hospital a few years back- no valium, no nothing...My husband has continued issues that need another scope- but he won't go back, even with the promise by a less "barbaric" Dr. that they will knock him out- it was that awful- and this a guy who weathered prostate exams for no reason, yearly vaccines, losing a enough meat off his leg to show the bone and the Dr. telling him to buy a bandaid.. and he won't go back...<br />My daughter just had a scope. Full sedation. She woke up immediately with a grin- said that is how they should do all procedures. She has had an open muscle biopsy with just a local, twilight sedation for a kidney biopsy- she would go back without hesitation if her Dr. said she needed another scope.<br /><br />So, perhaps, the less barbaric the procedure with minimal risk via sedation these days, the more likely Drs. won't encounter- what we as patients so often hear complaints about - The Non-Compliant Patient.Dianehttps://www.blogger.com/profile/01017207805622932780noreply@blogger.com