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Abstracts: ENDOSCOPY

Dealing with Staff Social Conversations During Endoscopy: The Doctor's Dilemma

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Brahmania, Mayur MD1; Madill-Guenther, Janet RN2; Manishen, Wayne MD1

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American Journal of Gastroenterology: October 2012 - Volume 107 - Issue - p S719
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Purpose: Recently, two complaints were filed with Canadian physician licensing authorities by patients who overheard endoscopy staff conducting social conversations during their procedure performed with conscious sedation. To further categorize the extent of this problem, its impact on procedure performance as well as to learn how physicians deal with it, a survey was developed and distributed to local university and community endoscopists in Winnipeg, Canada.

Methods: An electronic survey was developed and sent to 22 endoscopists comprising gastroenterologists and surgeons practicing at 2 teaching and 4 community hospitals in Winnipeg. Each endoscopy unit is staffed with 2 nurses per room. The survey consisted of 10 questions concerning social conversations during endoscopy, focusing on the frequency of occurrence, level of distraction, endoscopist participation and strategies for cessation.

Results: Of the replying endoscopists (10/22), 100% reported hearing social conversations among staff during colonoscopy and 90% admitted to occasional participation. Sixty percent reported experiencing difficulty in task performance, procedure prolongation or errors due to extraneous conversation. Only 20% of endoscopists requested cessation of social conversation. Sixty percent feared staff retribution and instead tried indirect approaches to limit conversation, including asking for review of medications administered or abdominal pressure. Fifty percent of endoscopists stated that they would feel more comfortable trying an indirect, non-adversarial, coded request: “Could we please have some vitamin D (ecorum)?”

Conclusion: In our community, staff social conversations are a frequent occurrence during colonoscopy, often involving physician participation. Endoscopists are reluctant to attempt cessation requests, mainly due to fear of retribution. For risk management reasons, quality assurance and avoidance of patient complaints, endoscopy unit supervisors should caution against social conversations during procedures. When it occurs, a less confrontational, coded request seeking cessation of conversation such as “Could we please have some vitamin D(ecorum)?” may be a useful strategy to consider.

© The American College of Gastroenterology 2012. All Rights Reserved.