When Should a Patient Reject Colonoscopy?
Several times during my long career, intelligent patients who have good medical reasons to undergo colonoscopies have declined to proceed.
Many times over the years, I have witnessed the following scenario in my exam room. Here’s the set up of this one act play.
I’m seated at my desktop computer. The patient is seated before me. The patient’s daughter is seated next to her mother.
Scene I:
A patient comes to see me in the office with medical issues that strongly suggest that a colonoscopy should be performed. As an aside, it is not my practice style to issue a colonoscopy edict, but rather to present the patient with available options, which should always include no testing as an alternative. I may at that point strongly urge that the patient accept my colonoscopy recommendation, but at least the patient then knows the options with their respective advantages and drawbacks.
[Reader aside: Examples of medical issues that lead most gastroenterologists and physicians to advise colonoscopy include:
Rectal bleeding
Change in bowel habits
Anemia, or low blood count, with a suspected intestinal bleeding site
Several times over the course of my long career, intelligent patients who have good medical reasons to undergo colonoscopies have declined to proceed.]
Scene II:
The patient declines any form of colonic intrusion. The attentive daughter becomes apoplectic over mom's decision.
“Mom, you have to get this done. I did it and it was a breeze. Even Uncle Harry did it and he’s older than you.”
Of course, the patient’s view dictates the outcome, as it should. The patient in these cases is elderly and uses an entirely different playbook from the child, who would readily consent to the procedure herself. The child is entirely well meaning and frightened that her parent might harbor a serious condition, which is entirely possible. The patient views this issue, and life in general, through a different lens. Decisions are evaluated using a different set of weights and measures. The parent may have lived a long and full life and has personal priorities that differ from those of younger loved ones. When I witness these occasional conflicts in the office, the child is vexed while the patient is at peace.
Most of the time, a parent and child are in agreement with the chosen course of action. But not always. These situations taught me an important lesson that I never learned in medical school. Patients are unique individuals whose view of the world, accumulated life experiences and station in life may lead to unpredictable decisions. These plays often have surprise endings.
When transcatheter aortic valve replacement was brand new our hospital was the only place in Florida that did it, and I saw lots and lots of very old patients with severe aortic valve disease. They came with their concerned children, many of whom were themselves doctors and nurses. These patients were among the last of the Greatest Generation, the ones who saved the world. I'm eternally grateful for what I learned from
those wise old folks and their thoughtful children. A completely rational 94 year old might decide to have a procedure, and another equally rational 94 year old with slightly different priorities or values might decide to decline. Especially at that age, folks have earned the right to make their own choices!
Once a resistor, have had procedure at 50, 60 and 66 yr (week before last). And yes, I have had some unkind thoughts about the medical profession during the prep. At 60 yr 3 benign growth removed; this time 1 benign removed and learned that I have diverticulosis. I want to be here for spouse, 2 children, 6 grandchildren so I am glad to have had these removed. But I understand the issue with acceptance. Question/observation: is the purging of the G.I. tract beneficial in and of itself? It seems to be in my case. Similar to “cleansing” or “purging” routines offered at health retreats? Does colonoscopy reset the colonic microbiome, or vanquish, at least temporarily, dysbiotic yeasts/fungi?