Rituals in gastrointestinal endoscopy at the crossroads of shaman and science

Abstract

Background and aim Over the last decades, the length of time required for endoscopic procedures has greatly expanded. The aim of the present decision analysis is to study the interactions amongst various factors that have caused such delays and to compare the relative magnitude of their influences.

Methods Performance of gastrointestinal endoscopy is influenced by the interaction of five domains, that is, (1) patient discomfort and fear; (2) injury, disorder, and disruption; (3) rituals to reduce fear, prevent disruption, and maintain order; (4) administrators or various health providers carrying out a ritual; (5) information, knowledge, and science, which influence fear, prevent disruption, and curtail unnecessary ritualistic behavior. A Markov chain model is used to describe the interaction among the five domains.

Results Overall, science exerts the strongest influence, followed by fear and ritual as distant second and third most relevant influences, respectively. Disruption and administrator exert only a minor influence on the system of mutual interactions.

Conclusions Studying patterns of ritualistic behavior during endoscopy and subjecting them to means of scientific research could help eliminate redundancy, cutting unnecessary rituals, and thus making gastrointestinal endoscopy overall more efficient.

• References

• 1 Higgins J, Keller-McNulty S. Concepts in probability and stochastic modeling. Duxbury Press; 1995
• 2 Ross SM. Introduction to probability models. 7th. edn. San Diego, CA: Harcourt; 2000: 499-548
• 3 Sonnenberg A. Transposed Markov matrix as a new decision tool of how to choose among competing investment options in academic medicine. Comput Math Methods Med 2009; 10: 1-7
• 4 Sonnenberg A, Naugler WE. Models of influence in chronic liver disease. Liver Int 2010; 30: 718-724
• 5 Rizk MK, Sawhney MS, Cohen J. et al. Quality indicators common to all GI endoscopic procedures. Am J Gastroenterol 2015; 110: 48-59
• 6 Calderwood AH, Chapman FJ, Cohen J. et al. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc 2014; 79: 363-372
• 7 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48: 843-864
• 8 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 9 Sonnenberg A. Arguments against costly quality assurance. Gastrointest Endosc 2011; 72: 567-569
• 10 Prasad VK, Cifu AS. Ending medical reversal – improving outcomes, saving lives. Baltimore, MD: Johns Hopkins University Press; 2015
• 11 Hosamani P, Verghese A. Annals for hospitalists inpatient notes – rituals in chaos, the sacred in the profane. Ann Intern Med 2017; DOI: 10.7326/M16-2737.
• 12 Montross-Thomas LP, Scheiber C, Meier EA. et al. Meaningful rituals: A way to increase compassion and decrease burnout among hospice staff and volunteers. J Palliat Med 2016; 19: 1043-1050