Sloppy Docs Miss The Diseases



A paper in today’s New England Journal of Medicine concludes that sloppy docs suck.  In this very simple study of colonoscopy they showed that the docs who took longer to examine the colon with a telescope (ie were more careful and thourough) found more disease.  When I was in residency there was a doc in my program who we called “Dr. Daddledoo” – because his attitude was basically “that-will-do”.  Minimally good is not as good as it can be.

The study reports:

Doctors who take more time (more than 6 minutes) to look for cancerous and pre-cancerous tumours in the bowel using colonoscopy tend to be better at detection than those who take less time.
Dr. Robert L. Barclay compared rates of detection of colorectal adenomas (polyps or abnormal growths in the bowel or digestive tract) against the time doctors spent searching for them. They looked at data from nearly 8,000 colonoscopies performed by 12 experienced gastroenterologists over more than a year.

The researchers found large variations in the detection rates among the doctors.  The time the doctors spent on searching for growths varied from 3.1 to 16.8 minutes for examinations where no polyps were removed.

The results indicated that those procedures that lasted an average of 6 minutes or less tended to detect fewer polyps than those that took more time.

This true in many specialties and is intuitively obvious to most- the more thorough docs find more disease.  Interestingly in my fertility practice we keep track of out outcome data as part of mandated federal reporting.  Ouf IVF success rates are far above the national averages.  One reason may be that we are extremely thorough in making complete and accurate diagnoses.  We find that in most other programs patients had single etiologies reported for their infertility while most of our patients have multiple diagnoses.  We are thorough in making a complete diagnosis and it helps us have the best possible treatment and success.

Don’t be a Dr. daddledo. 

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