We’re Clinicians, Not Mere Technicians

Dr. Ronald Witzke’s letter (“Colonoscopy should be top colon CA screening test,” the Medical Post, March 9) is interesting. He implies my earlier letter (“Flexible sigmoidoscopy should be encouraged,” Feb. 3) recommends flexible sigmoid-oscopy as a screening tool for colorectal cancer for all age groups and all kinds of patients. That is not true.

Let me simplify my point. Colonoscopy is an excellent screening, diagnostic and therapeutic tool in the right hands, for the right patients and for the right indications. For others (as described in my letter), flexible sigmoidoscopy should be considered. There is nothing new in what I said.

Good patient care requires a good history and physical, good clinical judgment, responsible use of resources, good indications for the use of highly expensive and invasive tests, and appropriate followup of patients.

Those who are interested in the subject should read “The tyranny of the scope,” an editorial written by Dr. Noel Hershfield in the Canadian Journal of Gastroenterology (August 2002). Dr. Hershfield is a highly respected senior gastroenterologist at the University of Calgary. He laments the current culture of “endoscopy on demand” and expresses concern “about this wholesale epidemic of unnecessary endoscopic mayhem.”

I agree with him that we should not become mere technicians. We should remember we are clinicians first.

—Dr. Noorali Bharwani, Medicine Hat, Alta.

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