Propofol is not always or even usually used for colonoscopies, but if used in a controlled environment under proper medical supervision, it is reasonably safe. Of course, every procedure and drug has issues. A little valium or other benzo will reduce anxiety of those who suffer such issues.
1. Joan Rivers had been under the same anesthesia for numerous plastic surgeries. Joan died because she had her endoscopy preformed in a clinic that didn't have an anesthesiologist skilled in general anesthesia. Her family settled a lawsuit due to extreme negligence and the lack of proper medical procedure as well as lack of emergency response equipment and personal. The doctor doing her procedure was neither a general anesthesiologist nor a general surgeon. He was taking a photo of her with his cell, as she started into cardiac arrest. I advise everyone to avoid these clinics that offer a lower price and fast procedure service. Use a highly skilled general surgeon, a hospital (having a trauma response team available within minutes), and a general anesthesiologist. Propofol is used only in the medium sedation and has a very high safety rate. MD Anderson started using it exclusive because the lighter sedation posed the possibility that the patient might wake up and move during the procedure, making perforations more likely. A heavier sedation poses a longer recover time and other complications, and unnecessary for routine scoping and biopsies. 2. The risk of intestinal perorations is rarely seen in the hospital out patient setting I mentioned above. It is more common in the clinic settings run by gastrointestinal doctors. 3. Of course the cancers are not found until they can be seen, however surgeons routinely remove suspicious polyps that sometimes show a precancer presentation that leads to a 10 year routine being shortened, usually another one the following year, then usually 3 to 5 years depending on polyps removed during those follow-up procedures. 4. Not all polyps are removed during a colonoscopy by competent doctors, just the suspicion ones. I still have several old polyps that I have had since my late 40s. As with any medical procedure, go to the most competent facility you can with emergency services and question your doctors before you agree to anything. More people die from colon cancer by an overwhelming margin, than die from invasive scoping. No one in my family had a history of gastrointestinal or digestive cancer, but I did, so there is no rule and as you say a personal choice. I choose not to die from cancer or undergo chemo or radiation, if I can avoid it with a highly proven and relative safe preventative procedure.
"Question your doctor?" What type of answer would a patient expect from a doctor or dentist who wants a big check from Medicare? They will all say, "We're highly skilled & have an excellent safety record." They know you have no way of verifying anything they say. And once you're asleep, you won't know who's there, their skill level, etc. I've had several dentists try to sell me $40,000.00 worth of dental implants, telling me how safe & wonderful they are - "Our office has done thousands in 80-year-old patients with a 99.9% success rate. After a bit of research, I found otherwise - they would be especially risky for me. And after a dentist put me in ICU for 8 days with Sepsis due to his incompetency, I research everything. For $$$$$, they'll tell you anything. Re: Joan Rivers - we have no way of knowing what anesthesia she was given for any of her cosmetic procedures. But we do know Propofol is given during endoscopies & colonoscopies.
Many, many potentially deadly drugs are routinely given to countless people every day. There is nothing unusual about it. As the adage goes, “the dose defines the poison”. Risk:benefit.
Big check from Medicare? Now that's a hoot! Medicare pays doctors a lot less than they can collect from private insurance. This is why many specialist don't accept Medicare. I expect honest answers from all my medical doctors and have always received such or I switch doctors. Yes, anyone can access records on their doctors for malpractice. Also several online sites have patient reviews and it isn't surprising how many bad reviews some doctors get. Any doctor that won't answer straight forward questions concerning the patients care, should be reported or at least be reviewed on one or all of the many sites. No. we don't know that Propofol is always given for endoscopy and colonoscopies, because it isn't. There are several choices of drugs used and also as I posted before, 3 levels of sedation. Apparently you didn't read what I wrote in a previous post. Also note that I encourage everyone, especially seniors, to go to an accredited hospital that has good reviews for its day surgery and also pick a surgeon with several years experience that is willing to work with you and answers all your questions and tells you to call if you have anymore questions or concerns. If you don't understand what questions to ask or if you might not know if the doctor is a lying piece of poo, then take a knowledgeable person with you. I have accompanied several friends to their first meeting at the doctors office. If a doctor doesn't like to be questioned, then walk out immediately. I have walked out on endoscopy doctors twice for being arrogant or insisting that I use their method of cleansing. Also remember that the cleansing procedure can be what is dangerous for the elderly if not done correctly. Many seniors go to their scoping dehydrated and in poor physical condition. No competent place will do such a procedure if the patient is weak. Joan Rivers talked about some of her plastic surgeries. The lawsuit filed by her daughter, Melisa mentions her receiving the same sedation as she had when she died. She was given an overdose by an incompetent doctor in a clinic lacking in every way possible. She wasn't even weighted before the procedure and also the clinic didn't even have her current medications on file. It is wrong to condemn a procedure based on one or a few doctors incompetence. Everyone is free to either have invasive scoping or refuse it. Based on my personal experience and medical knowledge, I advocate such as a cancer prevention, but again suggest everyone avoid these clinics not connected with emergency care or lacks a general anesthesiologist.
I know that when I owned an ambulance company, Medicaid often didn't even compensate us for our actual costs, not even counting wages. They would pay us less than we paid for IV fluids, medications, and so on, and it could take us up to a year to collect anything at all from them, and we didn't have the option of refusing on emergency calls. We did refuse non-emergency transfers without pre-approval, however. On the other hand, someone with Medicaid and Medicare together was the Gold Card. If Medicare paid, as they usually did, then Medicaid would pick up the part that Medicare didn't. With Medicaid alone, they would deny perfectly legitimate claims, forcing us to appeal, and then they'd pay very little of the bill. Medicaid refused to pay on claims for people who later died in the hospital, claiming that it wasn't an emergency. People with Medicaid weren't likely to pay out-of-pocket though, so we had to take what we could get.
I get itemized statements on what Medicare pays my docs. Some times there are multiple statements covering the same visit but with different codings. I admit to not understanding how it all works out but I agree about the amounts Medicare appears to pay vs. what is billed. It’s absurd. We had a bit of trouble, when we switched family doc several years ago, finding a practice that would accept Medicare patients. If those payments are what they appear to be, it’s no surprise that many docs don’t want the business.
Yep, it is exactly what you see on the statement. My surgeon only takes on women and is selective accepting Medicare patients. She won't take on any without a secondary that pays what Medicare doesn't. On a recent $10K bill, Medicare approved $6K, but only paid $4800 since the other is either the patients responsibility or is paid by an approved Medicare part B coinsurance. Medicare has a Physicians Fee schedule so each physician can see how much they will get paid for a procedure. For instance a Neuro-Otologist gets paid the same as a lesser educated ENT for the same procedure. Sadly this leads to many ENTs doing procedures they shouldn't leading to permanent damage to the inner ear. I might note here for younger seniors not on Medicare yet, that you will pay for your Medicare and also part B supplement unless you are poverty level and get Medicaid and State Assistance. It isn't FREE for the former working folks. I pay out about $350 a month, including part D. My monthly drugs cost me $60 out of pocket. I don't have vision or dental since that supplement cost more than my yearly implant cleaning and one pair of glasses. Those supplements also max out quickly, so it is good money wasted for me to have either of those plans. Big city folks have options us rural folks do not to buy Advantage plans.
Medicaid varies by state I think. Up here, Medicaid pays fairly well, which encourages the recipients to clog the ERs with non-emergency issues. Medicare, however, doesn't reimburse enough to keep clinics and offices open. Hospitals have other sources of income from Medicare but not physicians, so, as @Faye Fox said, quite a number of docs won't accept new Medicare patients, although most will continue to see you if you have been a patient before you reached 65. That was why I proposed starting Medicare clinics as an option, not a requirement. If you had those, you could see a provider if you were on Medicare or new to an area with no co-pay or deductible as the overhead would be covered by government funding, much like the VA is. We have one of them here that is associated with a local hospital and the hospital gets the referrals from the clinic as well as (I think) a subsidy for providing the service. I haven't used it as I have other insurance, but I hear nothing bad about it.
Yeah, Medicaid is largely federally funded but administered by the state, which may or may not contribute additional funds toward it. In Texas, the state would invest the federal funding they received each year, then, by taking a year to pay off claims, they could earn a profit on the investments while the providers waited a year or more for payments. A lot of ambulance companies didn't appeal claims that were unpaid since they could then go directly to the patient for payment. However, being on the Texas-Mexico border, we learned that no one with Medicaid was going to pay out-of-pocket, so I began a practice of appealing every denied claim, even the ones that I thought were appropriately denied since sometimes they'd pay something on them on appeal. We learned about the state's policies from a whistleblower, but the knowledge didn't change the practice.
There are MILLIONS of stories and we all choose "our way" regarding all this invasive body stuff. Just today, another topic kinda, I called a friend in PA and she was sick as a dog in bed....YEP she took al the jabs and I know I "made her day" when I called her, but I spouted the info I've been following for years on the jabs and she has been one of those who people who question nothing from the docs.... Docs can come to us with high marks on all they do and we are all unique on outcomes. One of my theories on the doc who did my surgery, it was a Friday afternoon and he had done surgers all week and most likely was NOT sharp as a tack to start on my body. We can call it Hindsight...this theory never entered my mind as I was going Under....