What if they miss something? Colonoscopy worries

October 9, 2020 7:32 AM

I am scheduled for my 3-year colonoscopy (timing due to the type and size of the polyp they found) and after I scheduled for a Friday afternoon appointment, I did some searching online. Bad idea, I know. But I found some medical articles (peer reviewed, even!) about lower rates of detection and accuracy with afternoon appointments. Add to this what I read about how often polyps are just... missed, and I am filled with worry.

Some of the tips I’ve read include: get an early appointment and ask about the doctor’s rate of polyp detection. I can’t figure out if it’s the anxiety in me wanting to reschedule and research (which would put me at early December instead of late October) or if I should just keep the appointment I have, trusting that this doctor (same one I had last time) did find a relatively hard-to-spot type of polyp and removed it entirely, also during an afternoon appointment.

I am really feeling stuck and the recent death of Chadwick Boseman and the pandemic and election stress isn’t helping either, and could really use some wise words and perspective on whether I should change this appointment or keep it as it is.

Thanks.

posted by fleecy socks to Health & Fitness (15 answers total)

I say this as a colon cancer widow: Just go to the dang appointment.

This doctor has already proved trustworthy and capable of finding difficult polyps in the afternoon.
posted by magnetsphere at 7:49 AM on October 9, 2020 [20 favorites]

Go to the appointment. The more you put it off the less likely you are to go at all. Remember that something you can control, bowel preparation is the most important thing you can do to improve the detection rate. That is something you can control. Your doctor has already proven that they can detect hard to find polyps in the afternoon & I personally would trust their skill.
posted by wwax at 8:00 AM on October 9, 2020 [3 favorites]

What research do you intend to do in two months that would be more informative than your doctor’s rigorous medical school training and proven clinical expertise?
posted by sageleaf at 8:10 AM on October 9, 2020 [16 favorites]

Yours is a case of what physicians call the "Dr. Google syndrome." It is good to be knowledgeable, but not good to worry.

Back when we could fly, none of us worried about knowing how to handle an aircraft in turbulent weather. We put ourselves into trained and skilled hands. The same applies to physicians. You need an expert, and you have one.
posted by yclipse at 8:34 AM on October 9, 2020 [4 favorites]

Go to the appointment. It is better to go now than in December - too many unknowns for COVID case rates, they may be spiking due to everyone being indoors and the holidays. Or you may find another study somewhere about how having a colonoscopy closer to the holidays means more polyps are missed, or something else that convinces you it's still not a good time. On the Internet, you can always find something legitimate-sounding to talk you out of Doing the Thing.

You have already seen this doctor and this doctor has already successfully found a hard-to-find polyp and taken care of it in the afternoon. This doctor knows your medical history and will be on the lookout for other hard-to-find polyps. You already have an advantage with this doctor and should keep the appointment.
posted by castlebravo at 8:42 AM on October 9, 2020 [3 favorites]

Just a thought from a total non-med person, but optimize the potential for a quality exam. Get a list of the foods that are to be avoided like dark berries, blueberries, raw veggies, and remove all of that stuff from your diet weeks early. Then follow the cleansing process with great annoying care.
posted by sammyo at 8:51 AM on October 9, 2020 [4 favorites]

I understand your concern. But the doc will know that you're a 3-year re-scan for good reason (my rescans are 5 years, I think that's more average, so a 3-year is even more standout to them), and that will in all likelihood have their eyes sharper on you.

The article you read about afternoon vs morning was almost certainly on average, 10-year patients, in whom one wouldn't expect a polyp at all. You're not in that population, and you shouldn't expect to have their outcome (of 'tired' eyes).
posted by Dashy at 8:54 AM on October 9, 2020

Definitely go. Sounds as if you have a trustworthy doctor, and he already is alerted to the fact that you had a polyp. It sounds perfectly fine and nothing to worry about.
posted by DMelanogaster at 9:04 AM on October 9, 2020

I've read those articles too. But what they find is an effect that emerges on average over a large number of doctors and cases. That doesn't mean that there aren't also doctors who actually function better in the afternoon and might be more groggy or distracted in the morning. (Given how many of use are night owls versus early birds, I would expect at least a decent minority.) And even if your doctor is actually more alert in the mornings in general, there's no saying how they'd be on that particular day.
posted by trig at 9:15 AM on October 9, 2020 [2 favorites]

Definitely go now - there's a very real chance that the pandemic could cause "non-emergency" visits like this to be on hold for who knows how long, if the hospitals in your area become overwhelmed at some point in the future. It's impossible to predict but I wouldn't risk delaying.
posted by randomnity at 9:15 AM on October 9, 2020 [2 favorites]

Response by poster: Thanks everyone - can you tell I was spinning out? Anxiety is such a beast. I appreciate your kindness and encouragement and guidance. It’s so helpful.
posted by fleecy socks at 9:19 AM on October 9, 2020 [8 favorites]

I would go. Having said that, I am saying go because your alternatives are worse. Not going at all is obviously a poor option. Waiting until December to get a morning appointment is delaying and it will not materially increase the odds they find anything or better put not miss anything.

While your doc did find a hard to find polyp at an afternoon appointment the first time, I quibble with those who say s/he did good by you the first time. If you are truly paranoid, just because they found a hard to find one does not mean they did not miss one or more hard to find ones.

I think your confidence (pre internet lookup) in your doctor is well placed. The overall statistics mean nothing. It is all how your doctor does. Look at it like a baseball team. They may have finished the season 90 - 72, but their chances of winning the game 7 playoff has nothing to do with their season record, it is all on the pitcher of tonight's game. You have your #1 starting pitcher going for you. Give them the ball and let them do their thing. You will be the winner.
posted by AugustWest at 9:47 AM on October 9, 2020

Personally, as a GI doc, I'd be worried about postponing the procedure until December because there is no knowing what the case numbers will be in two months. As cases spike in my area, we are canceling a lot of elective procedures right now. If this were me, I would want to get it done now rather then risk having it canceled in December.

I'd also say, I think most of us are extra careful in patients who already had advanced polyps. Not that we are not careful in other patients as well but I do think it makes us extra vigilant.
posted by M. at 12:16 PM on October 9, 2020 [6 favorites]

Nothing to really do with the topic but I schedule all my doctors appointments for first thing in the morning. There has not been time in the day for schedules to slip and get backed up. I know I will be in and out quickly.
posted by tman99 at 1:34 PM on October 9, 2020

The effect of the time of day appears to be VERY small, and you already know your doctor is a careful endoscopist (and will be extra careful now, knowing that you've already had a polyp).

I think you should do your part to ensure a good study by following your prep instructions carefully, keeping your appointment, and move forward. Any colonoscopy is going to find more polyps than one that doesn't happen.
posted by The Elusive Architeuthis at 4:17 PM on October 12, 2020