Danielle Marino

Fear of the Unseen

As a young gastroenterologist, you may be faced with interval colon cancers or missed polyps at some point in your career. Due to variable lesion growth rates, there is inevitably an inherent miss rate of colonoscopy even if you use optimal examination techniques. The thought of missed polyps or cancers can be anxiety-provoking for young endoscopists, bringing with it the potential for significant medical and legal ramifications. In fact, colonoscopy represents the highest frequency of closed claims and indemnities among all endoscopic procedures [1]. Unfortunately, fear of litigation surrounding the development of interval colon cancers leads to overuse of colonoscopy for surveillance and inappropriate application of colorectal cancer surveillance guidelines, both of which are now tracked as part of your physician performance measures. In legal cases of missed or interval cancers, focus lies on determining whether the ‘‘standard of care’’ was met for the procedure in order to determine whether negligence occurred; if you practice within established standards of care, you will be a more difficult target for litigation. As trainees, we take comfort in knowing that the watchful eyes of our attending are there to see what we may not, at times even repeating the examination themselves. As training transitions into independent practice, those watchful eyes slowly fade, leaving us without this security. Fortunately, several established steps can be taken to ensure standards of care are met and thus protect your patients from the tragedy and you from the medicolegal ramifications of a missed polyp or cancer.