Too Many Scopes

Colonoscopy is overdone in this country.  This is an observable fact.  I see patients every single day who get scoped every 2-3 years for no discernible reason.  I see inpatient 90 year olds who present with "GI bleed" (really just a little coffee ground emesis from dehydration/mild peptic ulcer disease) who end up getting black tubes snaked through their mouth and anus before they are returned to the nursing home from whence they came.  This happens constantly.  A study from Archives of Internal Medicine elucidates this phenomenon:

The colonoscopists with percentages significantly above the mean were more likely to be surgeons, graduates of US medical schools, medical school graduates before 1990, and higher-volume colonoscopists than those with percentages significantly below the mean. 
A large percentage of colonoscopies performed in older adults were potentially inappropriate: 23.4% for the overall Texas cohort and 9.9%, 38.8%, and 24.9%, respectively, in patients aged 70 to 75, 76 to 85, or 86 years or older.
 

I post about this because, although the main problem with rampant, out of control healthcare expenditure in this country occurs at the macro-level via the health-industrial complex of hospitals, Big Pharma, the insurance carriers and the medical device industry, it doesn't excuse unscrupulous physicians acting like greedy assholes and the role individual doctors play in driving up costs.  Whether it's cardiologists performing unwarranted cardiac stent procedures or general surgeons taking out robin's egg blue gallbladders, we have to be able to shine the light on such behavior and shame those who betray basic medical ethics.