Grant A K, Harley H A
Br Med J (Clin Res Ed). 1982 Sep 25;285(6345):868-70. doi: 10.1136/bmj.285.6345.868.
Remarkable technological advances of fibreoptic endoscopy in the past two decades have produced important improvements in diagnosis and treatment of gastrointestinal and hepatobiliary disorders. These advances must be kept in perspective; continuing, critical assessment of their contribution to the management of patients is desirable. Endoscopy can have adverse effects on the total performance of departments of gastroenterology, on gastroenterology as a discipline, and even on the status of the medical profession in the community. Gastroenterologists need to show proficiency of performance and integrity of practice. Control may be achieved by certification delineation of privileges, peer review, public accountability, and realistic financial returns for procedures. Records of a department of gastroenterology indicate that some control may be achieved by insistence on a consultation before decision on endoscopy. This may be a desirable alternative to endoscopy on demand. Undue emphasis on technology runs some risk of destroying the proper practice of consultant medicine.
在过去二十年中，纤维内镜技术取得了显著进展，在胃肠道和肝胆疾病的诊断和治疗方面带来了重要改善。必须正确看待这些进展；持续、批判性地评估它们对患者管理的贡献是可取的。内镜检查可能会对胃肠病科的整体运作、胃肠病学这一学科，甚至对医学界在社区中的地位产生不利影响。胃肠病学家需要展现出操作的熟练程度和执业的诚信度。可以通过认证特权划分、同行评审、公众问责以及合理的手术经济回报来实现控制。胃肠病科的记录表明，在内镜检查决策前坚持进行会诊可能会实现一定程度的控制。这可能是按需进行内镜检查的一个理想替代方案。过度强调技术存在破坏顾问医学正确实践的风险。
