Waring J P, DiSario J A, Sanowski R A
Department of Internal Medicine, Carl T. Hayden VA Medical Center, Phoenix, Arizona.
J Gen Intern Med. 1991 Sep-Oct;6(5):436-8. doi: 10.1007/BF02598166.
To examine the patterns of use of gastroenterology consultations by internal medicine physicians.
A survey of licensed physicians in the three metropolitan areas in Arizona where gastroenterologists are available. The physicians were asked how likely they were to obtain gastroenterology consultations for a variety of different gastrointestinal illnesses. Comparisons between groups were done with chi-square analysis.
Forty-six percent of the physicians responded. The majority of respondents believed that esophagogastroduodenoscopy and colonoscopy should be available without gastroenterology consultation (65% and 64%, respectively). Physicians in practice more than ten years were less prone to request consultation for gastrointestinal complaints that were likely to result in endoscopic procedures, such as the diagnosis of peptic ulcer disease or inflammatory bowel disease, or guaiac-positive stool. Internal medicine residents were more likely to seek consultations for both endoscopic and cognitive gastrointestinal complaints. Internal medicine residents were far more likely to request gastroenterology consultations for most patients with upper-gastrointestinal-tract bleeding (91% vs. 60%, p less than 0.001) and lower-gastrointestinal-tract bleeding (65% vs. 22%, p less than 0.0001) than were internists practicing more than ten years.
The majority of internal medicine physicians would like to order endoscopic procedures without gastroenterology consultations, much as they order radiography. Recently trained physicians are far more likely to request consultants for procedure-related problems.
