This comes from a reader who has been following me since the Placebo Journal days:
You had asked us to send our examples of the the quality nonsense. Well, this is not a “quality measure,” but it is something that bothers me and seems to be getting worse.
Early on in my practice as a colon and rectal surgeon, when I would see a patient in my office with a fecal impaction, we would arrange for the visiting nurse to go to their home and disimpact the patient. We gave them instructions as to technique and the type of enema(s) to administer. It worked well.
I always examine these patients, including anoscopy to evaluate for a fissure (most do not have one). They are also given an appointment for follow up in 1-2 weeks to be sure it is successful. And, if they have not had a colon exam within the past few years, schedule one for them.
Then, Medicare stopped paying for the visiting nurse. So now these patients have to go to the E.R., it takes longer, and is considerably more expensive.
More recently, and even though we call the ER in advance and send with the patient a preprinted protocol of what to do, the patients are getting a CT scan (yes, a CT SCAN!!!) to be sure nothing else is going on even though they do not have abdominal pain.