Author Archives: petercotto

Enhancing quality in GI health care


How do you/we choose from all those who wish to serve us, whether restauranteurs, plumbers or doctors? How do we know which or who is good, or even excellent? Locally we can rely on our own experience and the recommendations of friends. But it is more difficult away from home. Some things like restaurants and hotels (and their guides) have grading systems, and the web is full of reviews by consumers that may influence our decisions. Price is a factor also. But choosing a doctor is much more difficult.

As I get older I begin to think more like a potential patient than a provider. How can I be sure of getting good treatment if I am dragged off a distant golf course in an emergency? Surely, hospitals only permit competent specialists to practice in their facilities? A recent survey suggests that is not always true, at least for one procedure that I know well.  “A survey of Credentialing for ERCP in United States”.  Published in Gastrointestinal Endoscopy, on line March 2017. I have written an editorial for Clinical Gastroenterology and Hepatology on how that situation might be improved, but the issue is much broader, and some of the same remedies apply.

Firstly, patients deserve to know more about their potential doctors, which means that we should all be comfortable collecting our performance data, and making it available when requested by anyone interested (patients, payers and even plaintiff lawyers). My repeated cry for gastroenterologists to keep “report cards” has been largely ignored, so far. There is a national system (GIUQIC) for reporting and benchmarking performance in the commonest endoscopic procedures, colonoscopy and upper endoscopy, but not for ERCP, by far the most hazardous. Most crucial is the fact that reporting is voluntary, and the less competent are unlikely to participate.

Of course, the overarching answer is for all of us to strive continuously to improve the quality of practice. There are plenty of erudite books, journals and meetings to help us, but there are few resources focused acutely on enhancing the patient experience.

Thus, I was recently pleased to join the board of SE HealthcareQualityConsulting, a company which provides resources to enhance safety and efficiency in many specialist domains. I have helped to develop the GI-specific Physician Empowerment suite of tools, designed to measure and improve patient experience and clinical effectiveness.

I hope that you will take a look at the “GI bundle” at

If you want to hear more, feel free to contact me at or call Stacia Pearce at 717.805.7829


A National Health system in USA?

The current bizarre health care “discussions” in Washington prompt me to comment. I grew up with, and served in, the National Health Service in Britain. When initiated in 1947 it was relatively inexpensive, since medical care was much less complex and most people died soon after retirement, if not before. The funding did not keep upContinue Reading

I don’t often sing, but….

I think I was selected for the choir at school for my looks rather than my voice. Indeed, I was asked to open and close my mouth , but try not to let any sounds out My reluctance to sing ever since was finally overcome during an emotional celebration of our 25th wedding anniversary at ourContinue Reading

Fred and friends go to the beach!

Delighted to announce that the 5th book about Fred the friendly snake is now published. Jack the boy’s Dad comes home from a trip and takes the whole family with Fred, Bernadette, Jungle Jim and all the animals on the ferry to Dewees island, where I live. They have a great time, but had aContinue Reading

International reunion on Dewees

One of the great benefits of my career has been to meet (some as trainees) special people from many countries, some of which have become closest friends. There is now a “gang” that meets every year or so in diverse places, consisting of five Australian couples (Tim and Susy Heap, Tony and Michelle Clarke, PaulContinue Reading

South Africa part three – CapeTown

After the wonderful week in the game parks with family, Marion and I headed to CapeTown, where I was to be visiting professor at Groote Schuur hospital. We splurged by arriving on the famous Blue Train from Pretoria. 36 hours of pampering, with great (too much) food. The landscape was rather monotonous until the mountainousContinue Reading

With family in South Africa – Phinda Mountain lodge

  We couldn’t believe that anything could top Makakatana, but Phinda did.   Great accommodation, with a plunge pool at each room. super service and food (too much). We had awesome rangers, Andy and Eric, and their trackers, Sibu and Mr M. Very knowledgeable but also fun. Nothing was too much trouble.      Continue Reading

With family in South Africa- Makakatana

Marion and I were so lucky to have been able to take all the English family on Safari earlier this month. We were actually 4 days late leaving USA (it took a total of 93 hours to get from Charleston to Johannesburg, another story), but arrived in time at Makakatana game park in KwaZuluNatal toContinue Reading

We lost a gentle man this week

Marion Wier passed peacefully a few days after his 74th birthday. He had a rare disease for which he had a successful bone marrow transport 15 years ago, but it came back with a vengeance and unresponsive to medication. He bore his illness with the grace that typified his life. His oldest son, Alex, wroteContinue Reading

The MagniFISHant seven gets a trophy!

Modesty has prevented me from previously blogging or bragging about my fishing talents. Truth to say that they have been somewhat hidden, but class has a way of finding its way to prominence. I am proud to announce that my team – the MagniFISHant seven– was on the podium yesterday when the prizes were awardedContinue Reading