Conference Coverage

How to direct refer for GI endoscopy



– Rheumatologists can save their patients time and the inconvenience of an unnecessary preprocedural office visit with a gastroenterologist by making a direct referral for GI endoscopy when appropriate, according to Uma Mahadevan, MD, professor of medicine at the University of California, San Francisco.

“Many health systems have access issues, and in most accountable care organizations, there’s a need to see patients within 14 days. It’s often easier to direct refer for the endoscopic procedure you want than it is to get an office visit and then the procedure,” the gastroenterologist explained at the 2018 Rheumatology Winter Clinical Symposium.

Dr. Uma Mahadevan Bruce Jancin/Frontline Medical News

Dr. Uma Mahadevan

There is, however, a right way and a wrong way to make a direct referral for GI endoscopy.

“We’re an open-access endoscopy center at UCSF, and I can’t tell you how many times a patient gets direct referred to us and – the night before the procedure, when we’re preparing for the case – we see that this patient can’t have a procedure tomorrow. Those patients have already done the bowel prep, they’re taking the day off work, they’ve arranged for someone to drive them, and they’re really mad,” said Dr. Mahadevan, who is also the medical director of the UCSF Center for Colitis and Crohn’s Disease.

Sometimes the procedure gets called off because the gastroenterologist sees that it would be inappropriate. For example, it would be inappropriate to perform an endoscopy on a patient with irritable bowel syndrome or fibromyalgia who has already had three negative endoscopic procedures in the past 5 years; alternatively, a screening colonoscopy would be inappropriate for an 80-year-old because the U.S. Preventive Services Task Force gives a class A recommendation for screening colonoscopy only during ages 50-75 years.

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