Things That Make Me Worry About My Colonoscopy

The Pentax Colonoscope. Source: University of Illinois Wiki

Sorry to get all Katie Couric on you, but I’m going to have a colonoscopy on Friday. I turned 40 last October and I have some family history that leads my doctor to get one done now rather than at 50.

Unlike Katie, I won’t be broadcasting mine live, but I’ll share some articles and reflections on the process and, being process focused, what could go wrong. It’s a very necessary procedure, but there are, sadly, some very unnecessary and preventable risks.

According to  Dr. Wikipedia (backed by journals):

This procedure has a low (0.35%) risk of serious complications

That’s about 1 in 300 patients, put another way.

For those of you who speak Six Sigma, that’s a 99.65% first time yield and a 4.2 sigma level.

That’s not going to scare me away.

Maybe I should have asked what my physician’s complication rates are. What are the complication rates at the surgical center where this will be done? Is this safer than being at a full-blown hospital or doesn’t it matter? Should I be more of an “engaged patient?”

Should I have asked more questions of my primary care provider? Why did she refer me to this GI specialist? Is he a “Best” doctor? Does that matter?

If I treat them as a supplier (respectfully), should I be able to walk the process and see what they do to prevent, say, instrument or scope disinfection errors?

Should I have asked:

  • Show me how you disinfect the equipment
  • Show me your training records for the people doing this work
  • Show me your equipment maintenance records
  • How do you verify that the work is being done properly?
  • Have you had any complaints or incidents in the past?

I had my pre-procedure phone call on Monday. Maybe I should follow up and ask a few of these questions, even if I can’t go “walk the gemba” to check things out myself. What would you do?

Of course, I didn’t have data or information available to me to know:

  • Which specialist is best at this?
  • Who has the highest or lowest complication rates?
  • What are the prices for different doctors or locations?

I don’t know how a busy person makes an informed decision.

These problems seem to happen way too often:

Dirty Instruments Lead to Investigation of Seattle Hospital

A Seattle hospital is under investigation after hospital officials revealed that more than 100 patients were put at risk of infection because medical instruments were cleaned improperly.

breakdown in training resulted in instruments used during colonoscopies being improperly cleaned, hospital officials said.

Scopes used during colonoscopies were found to have been cleaned improperly last November, according to a hospital statement.

Technicians used improper cleaning techniques on the scopes between July 2011 and November 2013, hospital officials said. As a result the hospital has started notifying 106 patients who were at risk of infection as a result of undergoing a colonoscopy during that time.

We’re going to look for what went wrong and what can be done and what has been done to stop it from happening again,” agency spokesperson Donn Moyer told ABCNews.com.

Why was there a breakdown in training? What are other hospitals doing to prevent this same problem? It’s good to react using good problem solving and improvement mindsets (looking at the process, figuring out how to prevent reoccurrence), but you can prevent these incidents to begin with?

Dirty Endoscopes Raising Alarms for Colonoscopies

A new study disturbingly discovered that an average of 15 percent of flexible endoscopes used to examine GI tracts and colons at five hospitals were harboring “bio-dirt”–cells and other material from previously examined patients. This was even after the instruments had been cleaned.

And that yucky finding is likely to be matched at other hospitals across the country, according to study author Marco Bommarito, Ph.d, lead research specialist at 3M’s infection prevention division.

“During a day [a single] scope may be used on half a dozen to a dozen patients–maybe even more.”

The article also says:

A guideline issued by the American Society of Gastroenterology said documented cases of infectious complications from endoscopic procedures were as rare as 1 in 1.8 million procedures.

But Bommarito thinks the actual number might be higher. He noted that it will not necessarily be obvious that a person’s disease came from an unclean endoscope used on them.

So you have detection problems and self-reporting problems. Will some healthcare organizations cover up problems and not inform patients?

Atlanta surgery center admits error in cleaning colonoscopy equipment

“One of our physicians asked the staff, ‘how do you clean these instruments?’ It was through that process, they identified that we weren’t using the high-level disinfectant,” Hamby said.

I realize “bad process” and “bad process management” runs rampant in healthcare. Poor training. Poor supervision.

These are not worker problems — they are management problems.

Lawmakers Blast VA Over Bad Colonoscopies

“What stops contaminated fluids from backing up into this tube is this crucial green valve,” he said, illustrating with a colonoscopy tube. “Investigators found not only was this valve missing, but this tubing wasn’t being cleaned in between patients.”

In surprise inspections at 42 VA medical centers on May 13 and 14, investigators found that only 43 percent had standard operating procedures in place and could show they properly trained their staffs for using their equipment.

Unclean Colonoscopy Equipment Affects 64 Colorado Patients

According to Denver’s 9News , patients who had colonoscopies between July 17 and Aug. 13 were being contacted via telephone and mail and told to be tested for HIV and hepatitis after it was discovered that the hospital’s disinfecting machine was not working properly.

St. Charles: Colonoscope Not Fully Sanitized

According to the suit, filed last week by attorney Jennifer Coughlin, the hospital failed to fully disinfect a scope that had been used on four previous patients last September.

A letter to the woman from St. Charles CEO Jay Henry acknowledged a programming error led to the final disinfecting steps to be skipped.

Hospital removes chief exec after dirty tools risked 2,500 veterans

The Miami Veterans Administration (VA) hospital is holding its chief accountable for improperly washed colonoscopy equipment that may have exposed 2,500 veterans to diseases, reports the Miami Herald.

After the colonoscopy scandal, the VA’s Administrative Investigation Board began inspecting the Miami VA facility and found it to have “poor quality control, lax supervision and sloppy procedures,” notes the Miami Herald.

Tainted Colonoscopy Equipment a Wide Spread Concern

Secretary Shinseki confirmed this was not a one-time or limited place occurrence. Shinseki went on to say this concern is shared system wide across VA hospitals, clinics, and medical facilities. 

Shinseki’s analysis concluded this problem was not the fault of a person not doing their job. Instead, this situation presented itself because of lack of proper standards being in place in all VA medical facilities. Following the investigation into the problem, more proactive procedures were put into place to make sure this practice does not continue.

Endoscopy doc ran dirty, dangerous clinic: Report 

A cluttered procedure room with five combustible oxygen tanks, “questionable” air quality, possible patient exposure to toxic fumes, contaminated garbage under the procedure table and a lack of monitoring of patients’ vital signs during procedures.

However, the most troubling of the observations are related to the possibility of dirty devices used during the scope procedures.

Some, like biopsy forceps, weren’t being sterilized using the right equipment, the report says.

During one procedure, inspectors watched the doctor dip forceps in a formaldehyde solution to get rid of a specimen and reinserted the forceps into the patient’s esophagus.

Healthcare is in no position to get on a high horse and lecture Toyota or GM about quality, eh?

Mark Graban (@MarkGraban) is a consultant, author, and speaker in the “lean healthcare” methodology. Hes is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus. Graban blogs regularly at Lean Blog, where this post originally appeared. 

17 replies »

  1. How do I go about getting my Gastro’s office inspected for cleanliness in Hollywood, FL? I didn’t see any cleaning of tubes, equipment between patients which was like a factory, one in and one out. I was rolled in the room while another patient is coming out. This goes on all day. When I asked the doctor about using a new scope, he said no. No one was cleaning the equipment behind him. Every staff in the room, was stumped when I asked if they get sterilized, cleaned and they said yes, after looking confused. I’m worried now. Very worried. I want his office inspected for cleanliness….how do I go about this?

  2. Hello
    I just received a letter from my Hospital to sya that the intruments used in my procedure were not sanitized properly, now I’m angry and scared.
    Can I sue this Hospital?

  3. May 2011 had CT scan, colon & upper @ same time in hosp, part of testing to figure out why pottasium 2.1 wht cell 11 throwing up etc. Within 4 days Left leg SWELLED REALLY BAD! Pain in left abdomin.
    9th day DEMANDED a CT scan..had LARGE wht area of infection,10th day surgery, apparantly developed necrotizing retroperitonitis! Awoke in ICU! Was cut down center & Lower Left had pump machine pumping out black! Left leg normal again! Dr. Said FLESH EATING BACTERIA WAS ATTACHED TO BACK ABDOMEN WALL! Recieved 3 more surgeries to remove infection/flush outs! 32 Days Fighting for my Life! Developed 7 other Infections/Fungus, Immune System Shot! It took 4 month for lower left wound to heal from inside to out with the help of Home Health Nurses! FOUND OUT Large Portion of Colon was Removed! Dr. NEVER TOLD ME OR MY HUSBAND! Does anyone know HOW I can find out on my own if Hospital/Dr. Cleaned equipment Correctly?? Or if Hosp had problems w this Dr making Mistakes w Colon Procedures?? Or if Hosp had One of the 8 Life Threatening Drug Resistant Infections I Developed due to my Immune System being Compromised?? When I do get my Yearly Colonopsy I go to a Dr.who is a Specialist GI & a Top Hospital Nationally. Also I Do ALOT of Praying!! Thank You & Would Appreciate Any Answers to HOW I Can Obtain this Info So I Can Give To My Attorney to Help With My Case!! (My Attorney Seems to Not Be Doing Her Job!)

  4. Dr. G, based on my experience with friends and loved ones, you’re right to be worried, unless knowing me happens to be the common factor, not the procedure.

    Infection–you betcha! Friend who happens to be a cardiologist made the mistake of traveling so a former resident mate of his could do the “dirty” deed. Sick–really, really sick. Like in the hospital, with IV antibiotics, considering surgical treatment sick.

    Bleeding—oh yeah. Nearly lost my aunt who bled at home post discharge after a couple of those pesky polyps were removed when she was 72.
    She’s still living in her own home and driving to Mass and cards and the Y at 90, so I guess all’s well that ends well.

    Except bleeding post polypectomy , getting transused FFP to reverse his Coumadin in my uncle with the prosthetic mitral valve didn’t work out so well in his case—big, life changing stroke for him as he was being wheeled out to the car when discharged. Kind of ruined my aunt his caretaker’s life as well. She left her job, so their retirement hasn’t been what they thought of financially either. That was thirteen years ago. They are both alive—but a massive impact on their quality of life.

    So, yeah, I don’t take these “screening” colonscopies lightly either.

    (And that’s not even including all the codes I’ve been called for over the years in the endo suite! They got a lot less once they realized Versed can’t be dosed like Valium, but they still happen.)

  5. Delightful post with a happy outcome, Good going, Mr. Graban. You raise all the right questions. Bubba’s comment was spot on.

    I had my one and only colonoscopy over five years ago and decided not to do it again for many of the reasons you cited. If I had a family history like Barry Carol I would not take any chances but my family was blessed with a pretty good deck of cards on both sides. I hadn’t thought about it until now, but that clean equipment business reminded me of those fecal microbiome transplant experiments that seem to be effective against C. diff.

    I’ve added you to my Twitter collection.

  6. Here’s another


    As they pay less per scopy, the hospitals and doctors want to do them quicker to increase volume. And there are many biopsies that are not indicated, since the scopist gets a fee for that, as does the hospital and the pathologist.

    The best scopists withdraw it slowly, to avoid missing lesions. How long is the withdrawal is the question, so ask it.

  7. I’m supposed to be “not working” but I am home and in bed.

    Everything went well. See my comments above about not asking any questions.

    The prep wasn’t that awful actually. It wasn’t fun last night and 2:30 am and 4:00 am, but the MoviPrep solution wasn’t that bad to drink.

    I was treated promptly today, with caring and friendly nurse, MD, nurse anesthetist, etc.

    I was given propofol, which I am assuming (bad to assume) that my insurance covers. Some insurance companies don’t consider that “medically necessary.” I had a $500 out of pocket payment for the center and MD. I might get billed for anesthesia, but not sure.

    With the propofol, it stung my vein a bit as they warned me, but it wasn’t that bad and I fell asleep. I woke up in a recovery room with my wife there and it was like waking up from a nap.

    If the experience is that pain-free for everybody, there would be NO concerns about getting this valuable test.

    They found no polyps or any concerns. No, it’s not a HIPAA violation to talk about my own care 🙂

    Now, I will just hope I don’t get a letter in the mail someday about them discovering a problem with disinfecting equipment…

  8. I end up not grilling them at all. I decided to, basically, put it in God’s hands, or however you’d want to put it.

    I talked with a good friend who is an airline pilot and patient safety / TeamSTEPPS expert. We decided that me asking questions wouldn’t provide any meaningful answers. He said that “the next generation will benefit from the work we’re doing now to improve the culture for patients.”

    There’s nothing unique about risks with colonoscopies. There are risks all around healthcare.


  9. To be clear, I liked the post.

    You’re asking the right questions. I’m just remembering the treatment I got the last time I went to the ER with a kid and started asking well informed questions.

    I’m just not sure how you do this. Any advice is appreciated.

    The news reports you highlight are certainly troubling. Who are colonoscopies special? Why so many problems that we don’t see in other areas of medicine?

    Is it that the equipment is difficult to clean?

  10. The prep is worse than the procedure, definitely! And the procedure goes very quickly. Find out how much/what type anesthesia is being used (that’s a question they’re used to answering). I actually ended up asking for *less* anesthesia than is usually given because I’m nervous about being put under and it takes longer to recover if they give you more; it was fine! I could feel it a little bit, especially when they “rounded a corner”, but it wasn’t painful (and they can always turn it up if it is).

  11. Just worry about getting around the splenic flexure. Everyone has a kink here and some have a really sharp kink, like 160 degrees.

  12. I had my first one 21 years ago. Number 8 is next week. The doctor who referred me the first time sent me to the same doc that does his. That was good enough for me. The worst part, I think is the prep. I usually sleep through the procedure itself. I also have a family history of colon cancer. Bottom line: don’t worry about it.

  13. I talked with a friend today who is an airline pilot and also does patient safety work.

    He tends to ask questions, as a patient, and gets asked (first) “are you a lawyer?” and then “are you a doctor?”

    The FAA finds deficiencies in airline operations all the time. It becomes pretty public. The airlines are under a lot of scrutiny and they’ve gotten safer.

    I don’t know the same can be said for this surgical center I’m going to.

  14. This is what is meant by “getting it up the a–“. I will say though, a family member just had one and found a cancer, so if it’s any consolation just be happy if they don’t find anything, or it’s small and easy to remove colonoscopically.

  15. Nice post.

    I am trying to imagine a member of the lay public asking some of these questions and picturing the likely reaction they’d get.

    Show me your maintanence records, please

    Glaring nurse. Are you out of your MIND?

    Ok. Well, can you verify that the work is being done properly? I mean, you guys know how to operate this equipment, right? I know it’s pretty complicated and I’d hate to have anything malfunction while you’re up in there ..

    Glaring for real now. Are you out of your MIND?

    Have you had any complaints in the past?

    Well, yes – there was a lady who came in a month ago who was pretty unhappy with the whole experience. No charges were filed.

    I think you’d have about the same luck as you’d have knocking on the cabin door of your flight to London and asking to see the pilot’s recent hours and the aircraft maintanence logs ..