Endoscopists who described themselves as “compulsive” and “thorough” had significantly higher rates of adenoma detection, according to results from a self-reported survey of 117 physician endoscopists.
Financial incentives, malpractice concerns, and perceptions of adenoma detection rate as a quality metric were not associated with endoscopists’ detection rates in the survey.
“Adenoma detection rates were higher among physicians who described themselves as more compulsive or thorough, and among those who reported feeling rushed or having difficulty accomplishing goals,” Ghideon Ezaz, MD, of Beth Israel Deaconess Medical Center in Boston and associates wrote in Clinical Gastroenterology and Hepatology.
These feelings were related to withdrawal times rather than daily procedure volume. “We hypothesize that performing a meticulous examination is mentally taxing and can cause a physician to feel rushed or perceive that it is difficult to keep pace or accomplish goals,” the researchers wrote.
Adenoma detection rates vary widely among physicians – up to threefold in some studies. Researchers have failed to attribute most of this discrepancy to seemingly obvious factors such as the type of specialty training an endoscopist completes. The traditional fee-for-service payment model is likely a culprit since physicians are paid for performing as many colonoscopies as possible rather than for procedural quality. Other potential variables include personality traits and endoscopists’ knowledge and views on the importance of adenoma detection rates.
To examine the roles of these factors in adenoma detection rates, Dr. Ezaz and coinvestigators used electronic health records data from four health systems in Boston, Pittsburgh, North Carolina, and Seattle. Detection rates were adjusted to control for differences among patient populations. Next, the researchers surveyed the physicians who performed the endoscopies about their financial motivations, knowledge and perceptions of colonoscopy quality, and personality traits.
Among 117 physicians surveyed, the median risk-adjusted adenoma detection rate was 29.3%, with an interquartile range of 24.1%-35.5%. “We found no significant association between adenoma detection rate and financial incentives, malpractice concerns, or physicians’ perceptions of adenoma detection rate as a quality metric,” the researchers wrote.
In contrast, endoscopists who described themselves as either much or somewhat more compulsive than their peers had significantly higher median adjusted rates of adenoma detection than did endoscopists who described themselves as about the same or somewhat less compulsive than others. These adenoma detection rates, in respective order, were 33.1%, 32.9%, 26.4%, and 27.3% (P = .0019). Adenoma detection rates also were significantly higher among physicians who described themselves as more thorough than their peers, who said they felt rushed during endoscopy, and who reported having difficulty pacing themselves, accomplishing goals, or managing unforeseen situations.
A secondary analysis revealed the same links between personality traits and adenomas per colonoscopy. The findings support an expert’s prior assertion (Gastrointest Endosc. 2007 Jan;65[1]:145-50) that the best endoscopists are “slow, careful, and compulsive,” the researchers noted. They recommended nurturing “meticulousness and attention to detail” during training and evaluating trainees based on these characteristics.
The National Cancer Institute provided funding. The researchers reported having no conflicts of interest.
SOURCE: Ezaz G et al. Clin Gastroenterol Hepatol. 2018 Oct 13. doi: 10.1016/j.cgh.2018.10.019.
