Researchers show that you want your endoscopist to be a type-A person — adenoma detect rates (ADRs) are higher among physicians who describe themselves as more compulsive or thorough, researchers report in the July issue of Clinical Gastroenterology and Hepatology. There was no association between ADR and financial incentives, malpractice concerns, or perceptions of ADR as a quality metric.
The effectiveness of colonoscopy in preventing colorectal cancer has been associated with an endoscopist’s ADR — the percentage of screening colonoscopies in which an adenoma is detected. ADRs vary among physicians, and patients screened by physicians with low ADRs have a higher rates of subsequent colorectal cancer.
Specialty training in gastroenterology has been associated with higher ADRs and reduced risk of colorectal cancer. However, these findings account for only a small part of the variations in ADRs. Other factors that might affect ADR include pay incentive (to perform as many colonoscopies as possible), and knowledge and perceptions of quality, or personality (differences in meticulousness and attention to detail while performing a colonoscopy).
Ezaz et al collected electronic health record data and calculated ADRs for physicians from 4 geographically dispersed health systems. In their study, 114 physicians complete surveys that assesses financial motivations, knowledge and perceptions about colonoscopy quality, and personality traits.
ADR was, however, associated with degree of self-reported compulsiveness relative to peers. Among endoscopists who described themselves as much more compulsive, the ADR was 33.1%; among those who described themselves as somewhat more compulsive, the ADR was 32.9%; among those who described themselves as about the same as others, the ADR was 26.4%; and among those who described themselves as somewhat less compulsive, the ADR was 27.3%.
ADR was also associated with perceived thoroughness (much more thorough than peers, ADR = 31.5%; somewhat more, 31.9%; same/somewhat less, 27.1%). Physicians who reported feeling rushed, having difficulty pacing themselves, or having difficulty in accomplishing goals had higher ADRs.
These results support the concept that the best endoscopists are slow, careful, and compulsive.
However, Ezaz et al found it surprising that physicians who feel rushed, perceive themselves as poor at pacing, or find it difficult to accomplish their goals had a higher ADR. They propose performing a meticulous examination is mentally taxing and can cause a physician to feel rushed or believe that it is difficult to keep pace. Or, that people with compulsive and thorough personalities have lower personal perceptions of ability.
Ezaz et al also found differences in ADR to associate physician’s ability to detect smaller polyps as well as right-sided polyps. Physicians with more thorough or compulsive personalities could be more likely to find and remove smaller polyps and detect right-sided polyps, which are more difficult to find.
There is evidence that a compulsive strategy can be nurtured. Although mandated minimum withdrawal times did not improve ADRs, instruction in enhanced inspection technique does increase ADR. Ezaz et al propose that it might be possible to teach trainees meticulousness and attention to detail, which should be considered in the design of interventions to improve ADRs.