Colonoscopies are something that few want to discuss but plenty of people want to know about! Robert Elsen did a good job for me so I'm glad to post this about him. His office at the medical center at the CPMC Davies Campus is well-run with pleasant staff (I think he works from other offices too). One thing that I didn't like was that I was required to sign away my rights to a jury trial as part of the intake procedure. This is such a bad policy. I guess that he's obliged to do this by his E&O insurance carrier, and I think he should get another carrier. But I signed it. I've knocked one star off my rating of him because of this.
He is attentive and speaks clearly and directly about a topic that makes many people squirm - his manner is generally reassuring. The best part about his approach to colonoscopy is that he agreed to allow me to have the procedure without anesthetic. This mattered to me because I have heard mixed reviews about the anesthetics used for colonoscopies (Elsen told me that he usually uses a combination of Versed and Fentanyl). I've also read that only about one in four patients suffer so much pain that they actually need anesthesia for this procedure (see http://www.ama-assn.org/amednews/2009/01/12/hll20112.htm ). So I was keen to do it without sedation. He agreed, provided that he could hook me up to an IV so that he could give me the anesthetic if the pain was unbearable. So that's what we did. Elsen seems to run a good and dependable practice, but without special qualities. However, I've given him an extra star because I really appreciate his willingness to depart from normal protocol for me.
Elsen owns a share in the Golden Gate Endoscopy Center, so that's where I went for the colonoscopy. It's a well-run place with helpful and pleasant staff. Patients have to have someone to drive them home afterwards because the sedatives make you unfit to operate machinery (my wife came along with me). There's a 2-hour time limit on street parking around there, so your driver will probably need to move the car once while you are there. Even without the anesthetic I was glad not to have to drive on the way home because I felt so uncomfortable with so much of CO2 that had been pumped into me and was still inflating my guts). The place is right across the street from Mel's Drive In, so my wife was able to enjoy a good breakfast while I was having the procedure.
Dr. Elsen's billing system doesn't work well, so I knocked off another star. I paid my bill on-time and 17 days after my check reached their bank they sent me a statement saying that I hadn't paid them. It's just a drag when I have to go to my bank's website, check that they got paid, call their office, etc.
Here are details about having my colonoscopy without anesthesia. No need to read this unless you're considering foregoing anesthesia yourself. Remember that everyone's gut is a bit different so it's unlikely that any two people will have exactly the same experience. First of all, it was a very weird and unfamiliar experience having a device pushed several feet into my abdomen. I'm sure that for some this weirdness alone would be enough for them to want sedation. Also this wasn't a situation where the physician is used to chatting with the patient (who is normally unconscious), so the team (1 physician and 2 nurses) didn't engage in conversation the way a dentist might have (no discussion about how well I look after my teeth and how nice they look etc.). So there was no significant attempt to "talk me through it," in fact almost all the information that I got about what was going on was in response to my direct questions (e.g. "how far in are you now?"). The procedure was often uncomfortable. At some brief times it was very uncomfortable. The lining of the bowel is completely insensitive, so the discomfort was all about the pressure caused by the inflation of the bowel with CO2 and by the manipulation of my abdomen to goad the device around the various bends in my colon. The nurses gave me a (sometimes quite forceful) massage to get the device around the various corners and, because my abdomen was so tightly inflated, this massage was often uncomfortable. But it wasn't so bad that I needed to resort to anesthetic. I'm very glad that I did it this way and I appreciated that this wasn't normal for the team and they were trying to make it as comfortable as possible. Although I had none of the "hang-over" after-effects of an anesthetic I did need a few hours to get over the stress of the procedure and to get the CO2 out of my system. So I was glad that I didn't have to go straight back to work. One more thing: it was a cold morning so I was wearing a pair of heavy wool socks. This was a really good thing because the room was not really warm and I'm sure that (in my nearly-naked state) my feet would have started feeling uncomfortably cold before the end of the procedure. read more
