FAQ’s

  1. What do you do at the Clinic?  Do you do colorectal cancer screening colonoscopy?
  2. Is The Pezim Clinic a ‘private clinic?’  What does that mean?
  3. Does the Clinic only see private patients?
  4. What is the difference between an MSP patient and a private patient?
  5. How many procedures do you do at the Clinic?
  6. How many doctors refer patients to the Clinic?
  7. Who actually does the procedures at the Clinic?
  8. How many doctors work here?
  9. Do I need to be referred by a physician to the Pezim Clinic or can I ‘self-refer?’
  10. How long is the wait to be seen at the Pezim Clinic?
  11. Will I be seen on time at the Pezim Clinic
  12. Do examinations at the Pezim Clinic hurt?
  13. What are the instruments and types of lower bowel examinations?
  14. I think I need a colonoscopy.  How do I know if I am healthy enough for a procedure at the Pezim Clinic?
  15. How long does a colonoscopy take?
  16. Why would a patient choose to have a colonoscopy at the Pezim Clinic as opposed to in a hospital?
  17. What if I am from out of town and I don’t want to wait for a colonoscopy where I live?
  18. How do I dress for a colonoscopy or any other procedure?
  19. Can I drive myself?
  20. How many colonoscopies do you do in a day?
  21. How long does it take to prepare my bowels for a colonoscopy?
  22. What products are available for colonoscopy bowel preparation and how do they differ?
  23. If I am just having a flexible sigmoidoscopy, what kind of bowel preparation do I need?
  24. Will I be put to sleep for a colonoscopy?  My cousin said he was ‘knocked out’ and remembers nothing.  Am I awake?  Can I watch?
  25. Will I feel drugged during the colonoscopy or afterwards?
  26. What intravenous medications are used for colonoscopy?  What are their effects?
  27. Will the colonoscopy medications interfere with the medications I usually take?
  28. Do I need to take pain medications after a colonoscopy?
  29. How long does it take for the colonoscopist to know if there is something wrong with my colon?
  30. What is a polyp?  What is the significance of a polyp?
  31. If you find a polyp, will you remove it during the procedure?
  32. What if you find something that looks suspicious?
  33. Is there anything special I should be concerned about if I have had a polypectomy?
  34. How soon can I eat after a colonoscopy and what should I eat?  What should I eat if I have had a polypectomy?
  35. How soon after a colonoscopy can I drive?
  36. How soon can I return to sports activities after a colonoscopy?
  37. How soon can I go back to work after a colonoscopy?
  38. How soon can I travel in a plane after a colonoscopy?
  39. How soon after a colonoscopy can I begin drinking alcohol?
  40. How is the equipment at the Pezim Clinic sterilized?
  41. I have no abdominal symptoms.  When should I get my first colonoscopy?  How often should it be done?
  42. What is virtual colonoscopy (CT colonoscopy, CT colon)?
  43. Do you perform CT colonography at the Pezim Clinic?
  44. Do you send patients for CT colonoscopy?  Which is better – colonoscopy or CT colonography? 
  45. Understanding a private clinic, including costs, coverage, and standard of care


1. What do you do at the Clinic?  Do you do colorectal cancer screening colonoscopy?

 •  The Pezim Clinic is a Lower Gastrointestinal (GI) diagnostic and treatment centre.  That means that we specialize exclusively in diagnosing and treating patients with abdominal and intestinal disorders.  We perform many colorectal cancer screening colonoscopy procedures and use colonoscopy to assess patients with positive FIT tests.  We also specialize in anorectal surgical problems.  Because we have our own equipment and a full-time clinical commitment, we are able to see patients and diagnose and treat them far more quickly than most hospitals or other specialists.

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2. Is The Pezim Clinic a ‘private clinic?’  What does that mean?

 •  The Pezim Clinic is a private clinic.  This does not mean that only private or privileged or special patients can be seen.  In fact, the vast majority of the work carried out at the Pezim Clinic, including most proctology work, is covered by MSP. And it does not mean that once you have been seen or diagnosed in a private clinic that you can ‘t be seen or treated in the public system.  All it means is that the cost to maintain the Clinic including rent, staffing, purchase of equipment and supplies is the financial responsibility of Dr. Pezim.

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3. Does the Clinic only see private patients?

• The Clinic sees primarily MSP patients but will also see private patients.
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4. What is the difference between an MSP patient and a private patient?

• An MSP patient will have all or part of his/her service paid for by MSP.  A private patient is required to pay the full cost of his/her service.
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5. How many procedures do you do at the Clinic?

• The Clinic sees 4,500 patients per year and undertakes about 1,000 procedures each year.  The Clinic staff’s cumulative GI diagnostic and treatment experience is over 80 years.

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6. How many doctors refer patients to the clinic?

• Over 700 physicians have referred patients to the Pezim Clinic.  Patients have come from across Canada and a number of other countries.

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7. Who actually performs the procedures at the Clinic?

• Dr. Michael Pezim performs all diagnostic and surgical procedures, with the help of the Clinic’s nursing and support staff.

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8. How many doctors work here?

• Currently, Dr. Pezim is the only surgeon at the Clinic.

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9. Do I need to be referred by a physician to the Pezim Clinic or can I ‘self-refer?’

• Most patients that we see are referred by a physician.  Patients can self-refer, but in such cases they will be treated as private patients.

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10. How long is the wait to be seen at the Pezim Clinic?

• We normally see patients within 1 to 3 weeks.  However, we will see patients the same or next day as a ‘fit-in’ if the problem is urgent.

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11. Will I be seen on time at the Pezim Clinic?

• We have extensive data to show that we can see patients much sooner than most other centers or physicians.  We have now saved patients over 1,000 years of waiting.  While this is all good, we cannot guarantee that we will see you on time on the day of your appointment.  This is because it is impossible to know the amount of time required by each patient or procedure carried out during any particular day at the Clinic. While we do our best to stay on time at the Clinic, it is not our first priority.  Our first priority is the highest quality patient care and safety.  That cannot be accomplished if one is rushing, not listening, not explaining, or running a clinic like one would run a factory or a standard business.  Successful patient management requires an attitude that says “I will see one patient and a time, and I will give 100% of my thinking to that patient while I am with him/her, and I will take the time required to get this right.”

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12. Do examinations at the Pezim Clinic hurt?

• Generally, no.  Bowel examinations are not particularly pleasant, but they should not be painful if done carefully by an examiner with substantial experience, gentle technique, and the right equipment.  If your problem is a painful issue such as a very painful fissure, there may be some discomfort or pain involved in just confirming the diagnosis and making sure there is not a complication such as an infection.  Often that can be done without a full formal examination so that when the problem is a painful one, examinations of the area are very limited.  Just enough to make sure we are not dealing with something that needs urgent intervention.  In addition, we are one of the only clinics that make extensive use of pediatric and infant instruments, even for adults, in order to minimize the discomfort of examination.  We maintain an inventory of some of the smallest bowel examining instruments in Canada for examinations in patients with painful problems.  These instruments are no longer made and most doctors have never even seen them.  Most clinicians now have gone over completely to using disposable examining instruments because the cost of sterilizing large numbers of instruments today is something that most clinics and doctor’s offices cannot handle.  While disposable instruments are fine, and we use perhaps more than anyone else in the province, they are large diameter and are too painful for many patients with certain problems.  So in patients with a painful problem, we use our tried and true reusable pediatric instruments from the 1970’s, and patients are often amazed that we have been able to complete an examination on them without hurting them.  These rare instruments are meticulously scrubbed and steam autoclave-sterilized between uses, with both chemical and biological markers and time and temperature computer documentation to ensure the highest efficacy of sterilization.  They prove immensely valuable in allowing us to make quick simple assessments of patients that most other clinics would consider unexaminable.

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13. What are the instruments and types of lower bowel examinations?

In general, there are three types of lower bowel examinations – short, medium, and long.

• The short examination uses a rigid sigmoidoscope to examine the low rectum.  The procedure is called ‘sigmoidoscopy’.  A sigmoidoscope is a rigid plastic/disposable or metal/reusable instrument.  It is basically a fancy pipe.  It is useful for examining the anal canal and the lower few inches of the rectum.  Rigid sigmoidoscopy is considered a standard part of a consultation at the Pezim Clinic, and is usually done without any bowel preparation.  There is no intravenous and no sedation given so patients may drive themselves home.

• The medium examination is called ‘flexible sigmoidoscopy’ and is done with the use of an expensive flexible reusable camera (flexible sigmoidoscope or colonoscope). There is no sedation, and the bowel preparation required is usually limited to a couple of small cleansing enemas that one can buy in any pharmacy (Fleet enemas).  Flexible sigmoidoscopy is good for examining the bowel up to 60 cms, although often one can only get 25 to 35 cms before it becomes too uncomfortable to proceed further. There is no intravenous and no sedation, so patients may drive themselves home.

• The long examination type is a ‘colonoscopy’.  This uses a flexible instrument and aims to examine the entire colon.  The colonoscope is 5 feet long (160) cm in order to accomplish this, although it is rare for the entire length of the scope to be inserted to complete the examination.  Colonoscopy requires a formal bowel preparation that includes an oral purge, and intravenous sedation is generally used during the procedure so patients are unable to drive themselves home afterward and must be accompanied by a friend or family member on their way home.

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14. I think I need a colonoscopy.  How do I know if I am healthy enough for a procedure at the Pezim clinic?

• A consultation is generally possible at the Pezim Clinic regardless of the patient’s health status.  However, certain diagnostic procedures such as colonoscopy and surgical procedures are only performed on those who are basically well or who have medical issues that are well-controlled.  A full description of health status requirements can be found on the home page heading: ‘Am I medically-suitable for a procedure at the Pezim Clinic?’

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15. How long does a colonoscopy take?

• A colonoscopy can take anywhere from 20 to 45 minutes.  In general, a patient can expect to be in the Clinic for 2 to 2.5 hours for the entire visit, including pre-procedure, procedure, and recovery phases.

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16. Why would a patient choose to have a colonoscopy at the Pezim Clinic as opposed to in a hospital?

• Consultation and colonoscopy can generally be provided much more quickly at the Pezim Clinic than in a hospital or from a specialist who works primarily in a hospital. In addition, the setting is more relaxed and less institutional, the patient is assured of a very knowledgeable staff, the procedure is performed only by a highly-experienced specialist as opposed to a medical student or resident, and the complication rate of the Clinic is exceptionally low.  It is likely that the chance of encountering hospital-type infections is less in a non-hospital environment.

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17. What if I am from out of town and I don’t want to wait for a colonoscopy where I live?

• Patients whose primary residence is outside of the lower mainland are welcome to be seen and treated at the Pezim Clinic.  If you require a colonoscopy, we endeavour to provide single-visit consultation and colonoscopy but will ask you to provide a medical history and health status information by way of  questionnaire in order to determine if you are suitable for the procedure at the Clinic.  The Clinic receptionist will be happy to send you a questionnaire.  The information you add to the questionnaire is reviewed by the Medical Director who will then determine if you are suitable for a single-visit procedure.  In some cases, the Medical Director may request an initial consultation in order to determine the best way of proceeding.

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18. How do I dress for a colonoscopy or any other procedure?

• Wear casual clothing.  Please make sure you are not wearing any perfume, scented hair spray or strongly-scented shampoo or crème rinse, or any type of body lotion.  It is best not to wear any jewellery, and to remove rings ahead of time.

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19. Can I drive myself?

• If your procedure involves any type of sedation (most colonoscopies do), you must not drive yourself home, and you must be accompanied on your way home.  We do not advise patients to plan to taxi home alone.  It is safer to be accompanied by someone you trust.  Driving home after having a procedure with sedation is not only unsafe, it may be very costly since if you do have an accident your insurer may deny coverage.

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20. How many colonoscopies do you do in a day?

• We perform 5 to 7 colonoscopies per day on those days that we undertake procedures.

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21. How long does it take to prepare my bowels for a colonoscopy?

• ‘Bowel prep’ (bowel preparation) starts the day before your procedure, although you will be asked to limit certain types of foods beginning a few days before.  So, bowel prep and colonoscopy is essentially a two-day event.

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22. What products are available for colonoscopy bowel preparation and how do they differ?

Pharmaceutical companies are always coming out with new formulations for bowel prep, each marketed as easier on the patient than anyone else’s.  The reality is that none of them are particularly pleasant and none of them are much better than the others.  They do have slightly different features that may make one type more suitable than another for a particular patient.  The three main categories of bowel preps are: citromag prep, PEG prep, and sachet prep.

Citromag prep (Citromag, Citrodan) involves drinking two beer-sized bottles of a lemony fluid.  Citromag causes the bowel to produce a large amount of fluid and this fluid then cleanses the bowel.  This is the most common type of preparation used at the Pezim Clinic.  It is pretty well-tolerated (attested to by the Medical Director personally – ugh), and almost always provides a suitable prep for the procedure.

• The PEG prep involves drinking a large jug of a fluid containing polyethelene glycol (PEG).  This washes the colon out directly, as opposed to relying on the bowel itself to produce fluid.  PEG prep is useful in patients who may not have had good results from a citromag prep or other preps in the past.  It is very reliable but the patient does have to drink a lot of it.  We use it primarily on repeat colonoscopies when we know the last time the bowel prep (usually Citromag) was less effective than we had hoped.

• The sachet prep (PicoSalax, PicoDan) is basically a powder that the patient reconstitutes and drinks.  Some patients find this easier since it may involve the least amount of drinking.  But all preps do require the patient to maintain a good fluid intake during preparation to counteract the loss of fluid from the bowel.

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23. If I am just having a flexible sigmoidoscopy, what kind of bowel preparation do I need?

•At The Pezim Clinic we ask our patients to do a full colonoscopy prep. With a full prep, visualization is better, and if the examiner needs to remove a polyp during a flexible sigmoidoscopy, it is safer if the patient has a had a full, colonoscopy-type of bowel preparation.

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24. Will I be put to sleep for a colonoscopy? My cousin said he was ‘knocked out’ and remembers nothing. Am I awake? Can I watch?

• Patients are kept conscious during colonoscopy, they are not put to sleep.  Some patients tell their friends they were put to sleep , but this is incorrect, they just don’t remember that period of time.  Giving a patient enough sedation to ‘put them to sleep’ (make them unconscious) increases the risk of the procedure substantially since unconscious patients are not able to reliably manage their airway.  We, and most other examiners, sedate our patients, but not to the point of unconsciousness.  Our patients are awake but somewhat drowsy (the amount of drowsiness varies) and they are able to answer our questions throughout the procedure and often watch the procedure on the monitor if they wish, however, they may not remember much about it afterwards due to the nature of the medications. See FAQ #26 for Medications used. In medicine, everyone is different.  So the informed patient should not be looking to be knocked out for a colonoscopy, just sedated enough so that the procedure is well-tolerated.

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25. Will I feel drugged during the colonoscopy or afterwards?

• The modern sedation we use has a very subtle effect on most patients.  Some don’t feel very different at all, even though their tolerance for the procedure is increased dramatically by the medications.  In addition, the duration of effect of modern sedation medications is much shorter than the old days and most patients will feel normal within an hour or two.  But that does not mean that they should drive or operate dangerous equipment on the day of the procedure.

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26. What intravenous medications are used for colonoscopy? What are their effects?

• Two types of intravenous medications are given for colonoscopy.  The first medication is a pain-reliever (Fentanyl) to control discomfort. The second medication is a sedative to relax the patient (Midazolam). Midazolam has an amnesic effect, causing some patients to forget what occurs during the procedudre. 

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27. Will the colonoscopy medications interfere with the medications I usually take?

• Prior to booking you for colonoscopy, your list of medications will be reviewed.  If any changes need to be made to your usual medication routine, they will be discussed with you.  In general, drug interaction in this setting is rarely an issue.

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28. Do I need to take pain medications after a colonoscopy?

• You should not need to take pain medications after a colonoscopy.  In fact, if you do, you should contact the Clinic as there may be a problem.

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29. How long does it take for the colonoscopist to know if there is something wrong with my colon?

• Colonoscopy is a ‘real-time’ procedure.  In other words, the examiner is seeing the actual lining of the colon at that instant and so if there is anything obviously wrong, it will be seen immediately.  Abnormalities may be biopsied (a small sample taken during the colonoscopy) and the biopsy tissue sent to Vancouver Coastal Health (VGH) pathology for microscopic assessment.

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30. What is a polyp? What is the significance of a polyp?

• A polyp is lump on a mucous membrane (mucosal) surface, such as the lining of the colon.  Not all polyps are meaningful, but some, called adenomas, are growths and do have the potential to become cancers.  This transition from an adenoma to a cancer does not happen overnight.  The ‘polyp-cancer’ sequence takes anywhere from 7 to 15 years.  It is now believed that up to 20% of adults will have at least one adenoma polyp, so they are a lot more common than we used to think.  Clearly, if polyps are this common, the vast majority of polyps must never turn into cancers.

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31. If you find a polyp, will you remove it during the procedure?

• If a polyp is found during a colonoscopy, it will be examined visually by the colonoscopist and a decision will be made to either biopsy it, remove it or leave it alone.  It will all depend upon the appearance of the polyp, the status of the patient, effectiveness of the bowel preparation, how many polyps there are, etc.  In general, if a polyp is of significant size (3-4 mm or greater), it will be removed.  Smaller polyps may just be biopsied.  If the patient is undergoing a flexible sigmoidoscopy, it is more likely that a polyp will just be biopsied rather than removed.  This is because most patients do not take a full colonoscopy-type bowel prep for flexible sigmoidoscopy.  Typically, if a polyp is found at a flexible sigmoidoscopy, it will be biopsied and the results of the biopsy reviewed with the patient 3 weeks later.  If the biopsy shows an adenoma, a full colonoscopy will usually be planned in order to remove the polyp and to assess the entire colon to make sure there are no other polyps that need to be dealt with.  In the Pezim Clinic we have removed thousands of polyps of all types and sizes.

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32. What if you find something that looks suspicious? 

• If we find something that looks suspicious for a possible cancer we will carefully examine it to determine if it should be removed through the scope. If it is clearly a cancer it is best not to remove it through a scope. In such cases a biopsy will be taken and the site of the lesion may be marked with a tattoo so that at the time of surgery the operating surgeon can easily find the location of the polyp from within the abdomen (the tattoo dye can be seen from the outside of the colon). In other cases, there may just be a large polyp that is easy to remove, but large enough for cancer to have begun to develop in it. We know that polyps larger than 1 cm in diameter have an increased risk for cancer. So, in such cases we might tattoo the polyp location after removing the polyp just in case surgery is later required or if we just want to know exactly where the large polyp was when we are following up the patient with future colonoscopies.

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33. Is there anything special I should be concerned about if I have had a polypectomy?

• For a few days, there will be a wound in the colon at the site where the polyp was removed, and so a patient who has had a polypectomy should be prepared to avoid stressful physical activity for a week or so in order to minimize the chance of the polyp wound bleeding. In addition, very rarely, the cautery burn needed to prevent bleeding during a polypectomy will lead to deeper damage and a possible injury or hole in the colon wall. A hole from such an injury may take a few days to develop so any patient who has had a colonoscopy and polypectomy should notify their colonoscopist if they develop serious abdominal pain after a colonoscopy, even if it is several days later.

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34. How soon can I eat after a colonoscopy and what should I eat? What should I eat if I have had a polypectomy?

• Sometimes a colonoscopist will ask a patient to stay on fluids for a period of time if he is concerned about the base of a polypectomy site or if a colonoscopy was particularly difficult. In these types of situations, fluids will be gentler on the bowel and will provide some time for any injury to declare itself before the patient has filled the bowel with food. But in most routine colonoscopies, even if there was a polypectomy, the patient can resume a normal diet as soon as they want.

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35. How soon after a colonoscopy can I drive?

• It is recommended that patients who have intravenous sedation not drive for 24 hours after their procedure. If the patient flies a plane or operates particularly dangerous machinery, 48 hours are recommended.

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36. How soon can I return to sports activities after a colonoscopy?

• It depends upon what was done at the colonoscopy. If polyps were removed or the procedure was difficult, it is best to avoid sports activity for a few days. Your examiner will discuss this with you.

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37. How soon can I go back to work after a colonoscopy?

• In most cases, you will be fit to return to work the following day.

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38. How soon can I travel in a plane after a colonoscopy?

• Patients must be aware that delayed complications may occur after colonoscopy. This may include delayed perforation or bleeding, particularly if the patient had a polypectomy. Delayed complications, if they are going to occur, will usually manifest within 5 to 7 days. So getting into a plane for a long flight within this period of time increases the risk that such complications will have a serious outcome. We recommend that patients not travel by air for at least 5 days after a colonoscopy, unless it is a short regional flight to an area where good medical and surgical care is available.

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39. How soon after a colonoscopy can I begin drinking alcohol?

• Since you have had intravenous medications that can affect your level of consciousness and judgment, it is best to avoid alcohol on the day of your procedure.

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40. How is the equipment at the Pezim Clinic sterilized?

• A great deal of time and consideration is given to the process of sterilizing (reprocessing) our equipment between patients. Despite the fact that the number of documented cases in the literature of disease transmission from endoscopy (scoping) is so low, of all elements required for accreditation by the College of Physicians & Surgeons of British Columbia, none is so actively discussed, examined and regulated as is the issue of equipment sterilization. The Pezim Clinic has been carefully reviewed by the College, including on-site inspections by professional College-retained sterilization experts, and has followed all requirements of on-going and continuous improvement in equipment reprocessing. The Clinic maintains state-of-the-art sterilizers for its metal surgical equipment (surgical operating instruments) and reprocessors for its flexible endoscopy equipment (colonoscopy, flexible sigmoidoscopy).Wherever possible, disposable one-time-use-only equipment is used, even though much of the cost for such disposable equipment falls to the Clinic and cannot be recovered. In the case of metal equipment designed to be reused, the sterilization process includes programmed steam autoclaving with hard-copy documented time and temperature control. The very expensive and delicate flexible scopes used for colonoscopy and flexible sigmoidoscopy would be destroyed by steam autoclaving and so are reprocessed instead in a chemical bath within an industry-leading automated endoscope reprocessor purchased by the Clinic. Sterilization quality-assurance processes include daily chemical and biological assessment of sterilization efficacy. The records of all of these assessments become permanent Clinic documents.

• Reprocessing a flexible endoscope is a very labor-intensive and expensive proposition, even when utilizing automated reprocessors, and must be done with extreme care by people who are specially trained and experienced. Imagine having to completely sterilize the inside and outside of a $35,000 five foot long Nikon camera 6 to 8 times per day, without damaging it, and you will get some idea of what is involved. Even slight errors in the process can result in an $8,000 repair to a colonoscope. The Pezim Clinic organizes regular inspections of its flexible instruments by qualified scope technicians in order ensure they are in satisfactory working order and free of defects that could interfere with optimum clinical function or sterilization.

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41. I have no abdominal symptoms. When should I get my first colonoscopy? How often should it be done?

• Opinions on when and how an individual should begin having their colon screened varies. The answer that a government official (who has to optimize a limited budget amongst millions of people) proposes may well be different from a seasoned physician who is being asked the question by a single individual sitting in from of him/her.  

In the first case, the minister is looking for maximum cost-efficiency and safety and is willing to accept somewhat reduced accuracy, including the possibility that certain individuals with colon cancer will be missed by the less expensive but less accurate test. The Minister is asking the question: “can we reduce mortality from colorectal cancer in this community by using a simple and inexpensive test to find some colon cancer patients that might not otherwise be found?  We know we won’t find all of them, but will there still be an overall benefit?”.  The answer is yes. Inexpensive fecal occult blood testing (FOBT) and now the newer somewhat more expensive FIT test have been shown to reduce mortality from colorectal cancer in a population and so these are favorite tests for governments to use when ‘mass screening’ a community such as a province.  The more recently available FIT test is better than the previous FOBT test as the FIT test identifies blood specifically from the colon whereas the FOBT would be positive even if the blood was coming from other areas such as the mouth for example.

In the second case, the physician is being asked specifically by the patient to make sure they do not have colorectal cancer or its precursors.  The physician has a very different responsibility to this patient than the minister has to his population.  While the minister can accept a test that is wrong 50% of the time but still provides overall benefits, that level of inaccuracy as applied to a single individual feels horrible from the physician’s point of view.  The physician would have to say to the patient that the testing was completed and is negative, but there is a reasonable chance that the result could be wrong.  So for any particular individual, that is not so reasurring.

• For these reasons, the recommendations regarding screening by physicians and those who deal with the clinical aspects of managing patients on a daily basis may differ somewhat from the recommendations provided even by well-meaning government and its agencies.

• Currently, most physician organizations recommend beginning colorectal testing at age 50 in patients in whom there are no specific risk factors.  In those with risk factors such as first or second degree family history, many physicians will recommend that screening begin at 40 or at least ten years younger than the youngest person in the family with either colon cancer or polyps.  This testing should be by colonoscopy.  CT colonography is an alternative test if available, and it is highly useful in some settings, but it is not recommended by all physicians if there are colorectal cancer risk factors such as a strong family history or positive FIT test.

• How often one needs follow-up colonoscopy depends on many things including personal risk factors for colorectal cancer and what was found at the previous colonoscopy.  In general, if there are no risk factors, colonoscopy is considered to be good for 7 to 10 years.  Five years if there are risk factors.

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42. What is virtual colonoscopy (CT colonography, CT colon)?

• Virtual colonoscopy (colonography) is a CT scan specifically designed to examine the colon and upper rectum.  It is less accurate than standard (optical) colonoscopy, particularly for polyps smaller than 0.6 cm, but more accurate than the old fashioned barium enema x-ray.  There is no sedation used for CT colon, and no intravenous is given. A small tube is inserted into the anus and air is pumped into the colon to distend it as the CT examines the interface between air and bowel wall.  If the bowel does not distend (this sometimes happens in an area where there is spasm or diverticulosis), then the CT cannot evaluate that segment well.  This is a frequent weakness of the test.  There is less chance for a perforation with CT colon than with colonoscopy (although they have perforated a few during air insufflation), but there is radiation associated with a CT colon whereas there is not with a colonoscopy (equivalent to about 350 chest X-rays – not as bad as it sounds).  If a polyp is found on the CT colon, the patient needs to be referred for a colonoscopy, and in most cases, will need to cleanse their colon again before the colonoscopy unless it can be done directly after the CT colon that day or the same day.  It is a toss-up as to which is better tolerated by the patient. Both procedures require a complete bowel preparation.  In our experience with patients who have had both CT colonography and colonoscopy, almost all said they preferred colonoscopy. For some years, Pezim clinic staff performed almost all of the colonoscopies on the initial Lower Mainland patients undergoing CT colonoscopy and found to have polyps.  The Pezim Clinic co-authored a paper in the British Columbia Medical Journal along with 2 CT radiologist in the first report of the use of CT colonography in the province.  The Pezim Clinic feels that CT colonography is a very good alternative to colonoscopy and we order many of them every year. But we generally do this in patients that we do not want to colonoscopy, usually because of advanced age, medical risk factors, etc.  

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43. Do you perform CT colonography at the Pezim Clinic?

• CT colonography requires an expensive machine that is only available in hospitals or specially–designed private CT clinics.

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44. Do you send patients for CT colonoscopy?  Which is better – colonoscopy or CT colonography?

• We are one of the most active referral sources for CT colonography because we see so many bowel patients and many of them are more suitable for CT colonography than standard colonoscopy.  These are generally the patients who are older or infirm or in whom colonoscopy is not possible for technical reasons.  Which is better?  That depends on the reason for the test, the type of patient, etc. In general, if there are no unusual factors and the patient is of reasonable age and fitness, colonoscopy is preferred. It is more accurate, is more definitive in its ability to diagnose findings, can permit excision and biopsy of lesions such as polyps and cancers, has no associated radiation, is as well or better-tolerated, and is a more reassuring test when negative. However, there are times, such as those mentioned above, where CT colonography is the better choice.

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45. Understanding a private clinic, including costs, coverage and standard of care

Is the Pezim Clinic a private clinic?  What does that mean?

The Pezim Clinic is a private clinic.  This does not mean that only private or privileged or special patients can be seen.  In fact, the vast majority of the work carried out at the Pezim Clinic, including most proctology work, is covered by MSP. And it does not mean that once you have been seen or diagnosed in a private clinic that you can ‘t be seen or treated in the public system.  All it means is that the cost to maintain the Clinic including rent, staffing, purchase of equipment and supplies is the financial responsibility of Dr. Pezim.

 

Is the Pezim Clinic funded by a drug or instrument company or does Dr. Pezim have ownership or investments in medical devices or treatments?

Unlike some other private clinics, neither the Pezim Clinic nor Dr. Pezim have any investments, partnerships or any financial arrangements with any health care company or medical instrument company and so there are no conflicts of interest in our patient management.  We will apply whatever treatment or use whichever instrument we feel will do the best job for a particular patient on a particular visit.  The Pezim Clinic is not a franchise.  We are not beholden to any company or any program of treatment.  Extreme quality, individualized care is our only consideration.

 

Who covers the costs of colonoscopy at the Pezim Clinic?

Dr. Pezim receives a personal surgeon’s fee from MSP for MSP procedures, as do hospital-based surgeons.  However, unlike hospital-based surgeons, the costs to perform colonoscopy in the Clinic must be borne by Dr. Pezim.  Hospital-based surgeons have nothing to do with the costs of performing a procedure.  They simply perform a procedure, bill MSP for their personal surgeon’s fee, and leave it to the hospital to cover its own costs from the Ministry for the procedure that they just did.

 

Why doesn’t Dr. Pezim pay for the costs to perform Clinic procedures out of his personal surgeon’s fee?

Initially, this is how procedures at the Pezim Clinic were funded.  But as costs of the procedures began to rise and the personal surgeon’s fee stayed the same, it became clear that this would not be a tenable solution for long.  Now, the cost perform a colonoscopy or flexible sigmoidoscopy is greater than the personal surgeon’s fee Dr. Pezim is paid by the Ministry to do the procedure.  So if Dr. Pezim were to personally pay for the cost of doing a procedure, he would lose money with every procedure and the Clinic would have to close.

 

Is the fact that the Ministry does not financially support out-of-hospital colonoscopy a reflection that work at the Pezim Clinic is considered inferior to that of a hospital or that Dr. Pezim is less qualified than an in-hospital colonoscopist?

No.  In fact, the College of Physicians & Surgeons of British Columbia has stated that they expect the work carried out at an accredited Non-Hospital Medical/Surgical Clinics such as the Pezim Clinic to be at a higher standard than a hospital.  Dr. Pezim’s credentials, training, expertise and safety record are equal to or greater than any practising colonoscopist in Canada.

 

So how are the procedures paid for at the Pezim Clinic?

The vast majority of work, including consultations, diagnostic testing and treatments carried out at the Pezim Clinic are straight-forward, non-controversial MSP care, and the costs are covered with no charge to the patient.  But the Pezim Clinic is different from most doctors’ offices in that it undertakes certain procedures that are normally only available in hospital, such as colonoscopy, flexible sigmoidoscopy, hemorrhoidectomy, etc, and the costs of these procedures are not properly-covered by MSP when they are performed in an out-of-hospital setting.  So if the patient needs one of these procedures they are given a choice by the Pezim Clinic physician to have their procedure either in the public system (hospital) fully covered by MSP and with no charge to them, or at the Pezim Clinic where they will be asked to reimburse the Clinic for its cost of providing the procedure.  Unlike in the hospital, a procedure at the Pezim Clinic can usually be performed within a week or two of booking.

 

Is it necessary to have my procedure at the Pezim Clinic?

No, it is not necessary to have your procedure performed at the Pezim Clinic.  If you decide to have a procedure at the Pezim Clinic, you are making a choice.  Your procedure will almost certainly be performed sooner at the Pezim Clinic than it would in a hospital, and in a more personal and private setting than in a hospital.  In fact, the speed with which we can provide a procedure is over and above the standard of care determined by the Ministry and in a sense this could be considered unnecessary.  In every case, when a procedure is indicated, you will be given the option to be referred by the Pezim Clinic to a hospital-based physician for consideration for that procedure.  To be fully-informed, you should find out the timeline for these procedures in your part of the province.

 

How long is the waitlist at the Pezim Clinic?

Initial consultations are generally performed within 2 to 3 weeks of referral.  Colonoscopy booking generally takes 2 to 3 weeks from the date of consultation.  Patients who have same day consultation and colonoscopy will usually have their consultation/procedure within 3 weeks.

 

How many people are involved in a colonoscopy?

The colonoscopy team at the Pezim Clinic consists of Dr. Pezim, a Registered Nurse and a Colonoscopy Assistant.  Each team member has a specific job, but all monitor the patient carefully throughout the procedure all view the colon examination.   Scope position and findings are discussed amongst the team members during the procedure and consensus is reached as to the best approach to any pathologic findings.  The core colonoscopy team at the Pezim Clinic has a combined experience of over 80 years of colonoscopy examinations.

 

But I have MSP coverage, or am over fifty, or have been referred by a physician, etc?  shouldn’t I be able to have my procedure for free at the Pezim Clinic?

All of these things would make you covered for a procedure in-hospital provided it was determined to be necessary by a physician.  The hospital’s costs would be paid by MSP.  But the Pezim Clinic must cover its own costs for procedures regardless of whether you have MSP coverage or not, or whether you are a certain age or not, or whether you have been referred by a family doctor or not.  In fact, family doctors themselves have to cover their procedural costs at the Pezim Clinic, and we have done procedures on many of them and their family members.

 

So, the Pezim Clinic does mostly MSP work, but charges for certain things.  What does it charge for?

If you have MSP coverage, the vast majority of what we do is fully-covered and no cost to you.  This includes all consultations, all basic examinations including rigid sigmoidoscopy, non-operative treatments, all follow-ups, etc.  There are some charges for procedures that are expensive for us to provide and are not adequately-covered by MSP, so we do ask to be reimbursed for their cost.  These include:

Colonoscopy

Anorectal surgery – hemorrhoidectomy, etc

Cosmetic anal surgery

 

What are the charges for colonoscopy that the Pezim Clinic?

The costs are determined by FIT test status (‘Fecal Immune Test’ for blood in the stool), the presence or absence of symptoms and family history, and where you live in the province.  Please note that patients must fulfill the health status criteria for a colonoscopy at the Clinic (see website under ‘Am I suitable for a procedure at the Pezim Clinic?’)

FIT-Positive patient from anywhere in BC

The Pezim Clinic is currently offering a FIT colonoscopy program in which we will perform a colonoscopy on any FIT-positive patient in BC, for our cost of $625.

Lower mainland

New patient with Gastrointestinal (GI) symptom                       $625

Current patient as part of GI workup                                         $625

New patient simple screening                                                   $1,950

Outside Lower Mainland

Former patients being followed for pathology                            $625

Former patients with no pathology (screening)                          $1,950

New patients (FIT-negative)                                                        $1,950

* There is an additional equipment charge if polypectomy ($60) or tattooing ($100) is required.

**Patients who reside outside of the Lower Mainland and who choose to leave their health care district for a procedure at the Pezim Clinic will be billed as private patients (for colonoscopy only).

 

What are the charges for hemorrhoid banding?

There is no charge for the hemorrhoid banding procedure. 

 

What are the charges for hemorrhoidectomy under local anesthetic?

Hemorrhoidectomy is usually performed in the hospital under general anesthetic.  In some case, however, a patient may be suitable for hemorrhoidectomy under local anesthetic.  Unlike a hospital hemorrhoidectomy, which may take up to two years to schedule, a hemorrhoidectomy at the Pezim Clinic can usually be booked within 3 weeks of consultation.  Current cost for anorectal surgery, including hemorrhoidectomy is $625

 

What are the charges for cosmetic surgery?

Costs for cosmetic anal surgery vary with the amount of work performed.  The minimum cost is $625

 

Can I get these costs refunded?

Reimbursement fees cannot be recouped by the patient through the Ministry (MSP) or any other government agency.  In most cases, insurance companies will not cover costs of reimbursement fees.

 

If I have my procedure at the Pezim clinic does it bias my future care?  Am I still able treatment in a hospital if anything is found on my colonoscopy or any time in the future?

Having a consultation or procedure at the Pezim Clinic in no way negatively effects any subsequent treatment you may need and does not prevent you from going back into the public facilities for further care.  In fact, because we aggressively refer patients in whom we find a problem, many of our patients are seen very quickly in the public system, particularly if we find something important.  A review of patients who were found to have a colorectal cancer at the Pezim Clinic showed that our patients were more rapidly proceeding to treatment than those patients who had to wait the traditional period of time for consultation and colonoscopy in the public system.

 

Does the Pezim Clinic treat any patients for free?

Since its founding, the Pezim Clinic has performed many procedures without a reimbursement fee in patients who are unable to afford a fee.  At one time, up to 20% of cases were done this way and costs were paid for by the Clinic.  As costs of procedures has increased dramatically while physician payments have remained essentially unchanged, it has become more difficult to offer free procedures.  We still do this in selected cases in which there would appear to be a high chance of finding something significant even if the patient cannot afford the fee.  If we think there is likely to be something wrong, we will go ahead in order to save that patient a significant delay in the public system.

 

Payment methods, no show or later cancellation fees

Payments for reimbursement fees may be made by cash, cheques or credit/debit card.  If a patient does not appear for a scheduled procedure or cancels the procedure with short notice, this is expensive to the Clinic a time slot for another patient will have been lost.  Accordingly, patients who do not appear for their procedure or who cancel the procedure within two weeks of the procedure date will be billed a cost of  $400, which is roughly the Clinic’s fixed cost for that procedure time slot minus the disposables that were not used.

 

Can I recoup the reimbursement fee from MSP or any other government agency or insurance company?

Patients who choose to have a procedure at the Pezim Clinic are choosing a different standard of care from what the Ministry provides, in that it is generally faster than the standard, and would be considered unnecessary.  Accordingly, patients will not be able to recoup the reimbursement free from MSP or any other government agency.  Generally, insurance companies will not reimburse clients for these fees.

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