How to define a GI Doc who specializes in CD

I would think every GI doc has some patients with CD. Are there some docs who only take IBD patients?

One of my docs told me she has 20,000 patients (mostly colonoscopies) and 15 CD patients. She graduated 15 or 20 years ago from Mayo. Is she a specialist?

Just curious as to your opinion

Dave

there are certain GI fellowships that are better in IBD than others. if she did her fellowship 20 yrs ago odds are she didn't learn her IBD knowledge from fellowship at all (since the only meds out then were prednisone, mesalamine and azathioprine). Now Mayo is one of the top IBD centers. Nowadays they actually have a super specialization in IBD that is an extra year after fellowship at some centers.

If you do decide to switch, here are some questions to ask the nurse on the phone as you call around:

1) What percentage of your patients have CD?

2) How long have you been practicing?

3) Do you attend any CCFA conferences? (My last GI went to one every other year.)

4) Would you do a free consult so that I can see if we're a good fit?

5) What hospitals do you practice at? Do you have admitting privileges?


I maybe would work backwards - call a colorectal surgeon, who probably sees CD a lot, and ask what GI's in the area they would recommend.

To the best of my knowledge he only sees IBD patients or those searching for a diagnosis. The hosp. clinic he works out of is the Digestive Disorders Center and specifically he is on the IBD team.

My prior GI did have a few CD patients, but his is more a "routine scope" kind of guy. While he was very compassionate he had only basic knowledge and was confused when I insisted my joint pain was from Remicade(btw, it was) because he had never heard of this.

scifigal, that list of questions is brilliant, and I'm going to hold onto it for when I have to find my next GI (My current GI is a case of divine intervention- I wound up at student health with inexplicable nausea and diarrhea a couple times and they just happened to refer me to a GI who runs clinical trials for Crohn's at his practice). dfdavedf, good luck making decisions!

DfDave, perhaps her approach of "She might not have taken the most direct route to Dx, but unlike every other doc I have had in the past, she stuck with it and kept testing until I got a valid Dx" is frustrating to most people with an IBD and they leave her practice more quickly than you.

kazbern said...
No. If her incidence of CD were typical she'd have something like 400 patients (assuming the rate of CD in the general population is 2%). It seems like she's either actively avoiding CD or is piss poor at proper diagnosis.

Rate of CD is nothing like 2% of the general population (otherwise about 6 million would have CD in the US alone), but on the other hand you'd expect a population with GI issues bad enough to be referred to a specialist doctor to have a higher incidence of CD than the general population.

So yeah, back to what you said.

Re my GI. I have no idea what % of his patients have Crohn's (would be interesting to know though), but I know he goes to conferences and stuff, and reads studies. Easily the best GI I've had, but the next time I need a GI doctor (which won't be for a long time, I hope), I will do some internet research first. I don't have the patience to deal with clueless, indifferent doctors all over again, so I would look for somebody who has a stated interest in Crohn's.

You're right, NCOT. From http://www.cdc.gov/ibd/:

"Precise incidence and prevalence of Crohn’s disease and ulcerative colitis have been limited by (1) a lack of gold standard criteria for diagnosis; (2) inconsistent case ascertainment; and (3) disease misclassification. The data that does exist suggest that the worldwide incidence rate of ulcerative colitis varies greatly between 0.5–24.5/100,000 persons, while that of Crohn’s disease varies between 0.1–16/100,000 persons worldwide, with the prevalence rate of IBD reaching up to 396/100,000 persons.2 It is estimated that as many as 1.4 million persons in the United States suffer from these diseases."

So according to the CDC, dfdavedf's doctor has 20,000 patients - she could have something like 0 to 3 Crohn's patients and 0 - 5 UC patients and be within the predicted rate of incidence. But sick people usually seek treatment, so you'd expect her to have more than 10 IBD patients. The statistic of IBD reaching up to 396/100,000 indicates she should have 80 IBD patients or more.

Oh, and my whole town only has around 70,000 people, and my GI is not the only GI, so I guess he probably only really has a handful of Crohn's patients. I've never asked specifically, and at this point, I'm not sure I really want to know:) It does make getting that second opinion at U of Chicago seem like a good idea at some point.