Do It Because You Can or Do It Because You Should? Part 2

Capitalism appeals to our inner drive.  After all, the more we do, the more we achieve, and the more we're rewarded.  Or something like that.  As much as I believe in this economic freedom, it isn't always the best solution when a fiduciary is required.  I mean, we're human after all.  And unfortunately, this weakness was confirmed once more in a retrospective cohort study published early online earlier this week in JAMA Internal Medicine when the authors found that almost 1 in 4 colonoscopies in our elderly were potentially inappropriate, especially among surgeons, US medical school graduates before 1990, and those w/high volume practices.

But therein lies the rub: just what constitutes potentially inappropriate?  The United States Preventive Services Task Force recommends screening for colon cancer in average risk adults from 50-75yo.  USPSTF recommends against routine screening in 76-85yo although individual considerations may warrant doing so.  However, the USPSTF is adamant against screening any >85yo regardless of biologic age.  

So the authors found 119,477 Medicare beneficiaries who lived in Texas and underwent a colonoscopy from October 2008 to September 2009.  The colonoscopies were considered screening (as opposed to diagnostic) if there was no diagnostic indication.  These screening colonoscopies were then deemed inappropriate if they were performed early without pathologic indication (previous normal colonoscopy <10yrs ago), or performed in 76-85yo w/o diagnostic indication.

As a physician, I'd hoped that we were better than that, that we'd hold our fellow human beings up on a pedestal (not the other way around) and put their health & benefit above our need for financial recompense.  Unfortunately, it doesn't appear that we've learned anything since August 2011 when another study published in Archives of Internal Medicine came to the same conclusion.  Let's promise to do something because we should, not because we can.  Greed does not become us.

By the way, check out what the American Gastroenterological Association had to say (see #2 & #3) in their recommendations for ChoosingWisely.org.

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