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This is a story of quality improvement that evolved over a period of 18 months culminating in a presentation at the World Congress of Gastroenterology held in Montreal September 11 th thru 14 th 2005.

Colonoscopy, the endoscopic evaluation of the colon for colon cancer or precursor lesions or "polyps", is now one of the most commonly performed medical procedures worldwide. Many fear having the test. One of the reasons is the valid concern for pain during and after the test.

The nurse told the doctor that he needed to do better. The doctor was initially angry but accepted the challenge, changed and grew through this experience of criticism, introspection and positive action. Using cause analysis and close monitoring of changes in technique and outcomes, quality was dramatically improved.

I hope you find this presentation as interesting as I did creating it and I invite your comments.

Respectfully
Geoffrey Bernstein. M.D.