November 4th, 2008
What does it mean to be a gastroenterologist in 2008? Is our field moving in the right direction?
I suspect that most gastroenterologists were and are attracted to the specialty because it offered the opportunity to deal with multiple organs and diseases. My generation of gastroenterologists came of age along with the exciting and emerging ability to diagnose–and later manage–aspects of GI diseases with endoscopy. However, most of our days were still spent as consultants seeing patients in the clinics and inpatient units, ordering radiographic and laboratory studies, and occasionally performing endoscopy. Many of our patients belonged to us–they had IBD, chronic pancreatitis, peptic ulcer disease, peptic esophageal strictures, chronic liver disease, etc. We knew them and they knew us.
The world of medicine has changed, however, and with it the practice of gastroenterology. For many of us, most of our days are now spent “scoping” patients we have never met. Many of these patients don’t even have what would traditionally be thought of as a GI disorder. When we are not performing screening tests, we are often evaluating patients with chronic pain located somewhere in the abdomen. Many gastroenterologists no longer see patients with complex IBD or liver disease. For that matter, some of us don’t see hospital patients anymore, leaving this population to the newly arrived GI hospitalist. While these trends have invariably led to greater efficiency and more widespread cancer prevention screening they have also removed us from the primary care of patients with acute and chronic GI disorders.
I miss the old days! I think the new paradigm of open endoscopy, a one-time consult and then dismiss the patient back to the PCP, etc. has diminished our specialty. Endoscopy is an amazing and wonderful tool that has improved the health of our patients, but it also has become a barrier to the practice of gastroenterology. How do we take the best of modern technologies and efficiencies without losing the best of the old connection with our patients and our primary role in managing gastrointestinal diseases? My own take is that, as individuals, we need to re-embrace providing primary care to patients with GI diseases and convince our colleagues to see the value of the “old-fashioned” gastroenterologist and make it easier for us to be one again.
What do you think? Should gastroenterologists be more involved in patient care? How did we lose our way? How do we find it again? Are we gastroenterologists or just endoscopists? And primary care physicians, what role do you see for the gastroenterologist in the management of GI disease?