Opportunity costs of endoscopy

doi:10.1136/bmj.b1071

Published 17 March 2009, doi:10.1136/bmj.b1071
Cite this as: BMJ 2009;338:b1071

Letters

Nurse delivered endoscopy

Opportunity costs of endoscopy

The first 150 words of the full text of this article appear below.

Norton and colleagues refer to the opportunity costs of endoscopicprocedures performed by doctors and consider whether their timecould be more effectively spent elsewhere.¹

Of course, you might ask the same question about whether valuableclinical nurses are best used as endoscopists. Acquiring themanual skills to perform these procedures is quite straightforward.Indeed, the recent pilot study by the UK Department of Healthconfirmed that administrators, healthcare assistants, phlebotomists,and clinical physiologists can all be successfully trained tobecome endoscopy "practitioners."² The opportunity costs ofthese workers may be even lower than those of nurses.

For a well defined, large volume screening test such as flexiblesigmoidoscopy in symptomless patients this may be a reasonable,perhaps even cost effective, approach. However, evaluating patientswith gastrointestinal disorders requires more than practicaldexterity. It relies on a physician’s ability to interpretsymptoms and signs and understand the natural history of . . . [Full text of this article]

Richard J Aspinall, consultant physician¹

¹ Department of Gastroenterology and Hepatology, University Hospital of Wales, Cardiff CF14 4XN

richard.aspinall@cardiffandvale.wales.nhs.uk