Patient Stories, Respiratory Compromise

Anesthesiologists and Colonoscopies: A Lesson in Better Physician-Patient Relationships

By Patricia Iyer MSN RN LNCC

(Pat is a legal nurse consultant who provides education to healthcare providers about patient safety. She can be reached at patriciaiyer@gmail.com)

I went to see a gastroenterologist (Doctor A) because I am due for a colonoscopy. I had a colonoscopy done 4 years ago by a different doctor (Doctor B), and one closer to home. Doctor A wanted to know why I had not returned to Doctor B for this new one. I explained Doctor B and I had not clicked. This is what happened, and it is a good lesson for what not to say or do to a patient.

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Anesthesiologist present at colonoscopy – a request

Four years ago, when I met with Doctor B in his office, I said I wanted an anesthesiologist to be present during my test. (The theory behind having the anesthesiologist present is that this person permits the gastroenterologist to concentrate on the procedure without having to stop to administer more medication to the patient. A colonoscopy is an uncomfortable test for people who have to endure it while awake.) He said I would have an anesthesiologist. The test would be performed in his office on a Thursday. Then I got a call that the test was being moved to a Friday and would be at the hospital. “Yes, there would be an anesthesiologist there,” the secretary told me.

We’ll take care of you if you have a cardiac arrest

When I showed up at the hospital on that Friday, I waited for the anesthesiologist to come by my stretcher. No one came. I asked the holding room nurse when I would see the anesthesiologist. She told me, “Oh, you won’t have an anesthesiologist. The doctor gives his own drugs.” When I looked concerned, she asked me why I wanted an anesthesiologist there. I told her I thought it was safer. She replied, “Oh, don’t worry. If you arrest, we have a button on the wall to get the code team. The whole hospital will come running.” At that point, the thought of arresting had not entered my mind. If I had not been fully prepped for the procedure, I would have gotten off the stretcher and gone home.

“He gives his own drugs” translated into the OR nurse injecting me with something that took away awareness (thankfully).

Dr. A looked amused when I told him this story. I said, “I know what the nurse said was technically correct. I had just written an article about rapid response teams. I have been a nurse for 40 years. I used to teach CPR. But it just hit me wrong in the state I was in.” He disputed whether it was safer to have an anesthesiologist there and said for years he gave his own anesthesia with no respiratory complications. After he started using an anesthesiologist, he had 3 respiratory complications but he was not saying there was a correlation. He assured me I would have an anesthesiologist for the procedure.

Legal nurse consultant revealed

But the awkward moment came when he asked me my occupation: “Nurse.” “Where do you work? “I have my own business helping personal injury attorneys.”

“Oh, you are one of THOSE nurses,” he quickly said (I am not sure what that meant, but the implication was that it was not good.) I replied, “And I won’t ask you if you do expert witness work.” He said, “Oh, I’ve been asked plenty of times. I have helped the insurance carrier point them in the right direction, but I don’t take the case.” I said, “Some doctors love expert work and some avoid it.”

I did notice after that I got letter perfect care, a full informed consent, and careful instructions for my prep.

Patient Advocate Lessons Learned

If I had the experience today that I had four years ago, I would have handled it differently. I felt betrayed that my specific request for an anesthesiologist was ignored. Furthermore, while I realized the nurse was trying to reassure me about the safety of the colonoscopy experience, her choice of words was very upsetting. The combination of the two factors close together set me on edge.

Several people who have heard this story asked me why I did not leave without having the procedure done. The unpleasant experience of the bowel preparation would have needed to be repeated if I had the procedure done at a different time. And while I wanted an anesthesiologist there, I knew the procedure could have been done with the doctor giving me anesthesia. My sense of trust in both the doctor and the hospital was affected. What I would have done today is to write a letter to the doctor to discuss the scheduling glitch and to express concern that my wishes were not followed. I also would have told the nurse that her comment about what would happen if I arrested made me even more nervous about being there. I know she was trying to make me feel safer. It had the opposite effect.

If your healthcare providers do not respect your wishes, it puts you in an awkward position. You have to decide if what you are asking is reasonable, and if it is, what are your choices. This is not an easy decision.

As it was, I got through the experience without problems, no complications from either the procedure or the medication. When I got the letter from Doctor A’s office reminding me it was time for another colonoscopy, I knew I was not going to return to him. My decision took money out of his pocket, and placed it in Doctor B’s pocket. There is some satisfaction in that. Sometimes switching doctors is all you can do, but for me, this was enough for now.

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