Category Archives: Medical

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

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

Our EPISOD research project finishes after 9 years.

  This one is medical, but I will try to make it intelligible. EPISOD stands for “Evaluating Predictors and Interventions in Sphincter of Oddi dysfunction”. That pesky sphincter described by Mr Oddi is the valve that controls the flow of juices from the liver and pancreas into the small intestine (duodenum). If it overacts itContinue Reading

Honoring my best old friend

Honoring my best old friend

I went to visit Dick McCray this week. Sadly he is unwell. We met first in 1971 in New York. I was on my first trip to USA, traveling across west to east on my way back to England after spending 3 weeks in Japan looking at and learning a breakthrough technique that became knownContinue Reading

Wow! Messages from 45 years ago

Amazing emails last week, from Sue and Judy, who helped me get started on my endoscopy career. Around 1970 I was running a small GI endoscopy service at St Thomas’s Hospital in London (although still officially in training). There were few resources and no one knew how it would all blossom into a huge industry.Continue Reading

Five years already!

My recent posts have been mainly about my books, now 5 about Fred the friendly snake, and my memoirs, “The tunnel at the end of the light”. The latter tells about my career as a gastroenterologist (a specialist who helps patients to get square meals through round holes). I am reminded that I stopped doingContinue Reading

Down memory lane at The Middlesex Hospital

In London in January for a wander down memory lane