In his response to our letter to the editor [June 2006], Dr. Sanford Brown misconstrued and misrepresented some of our comments. First, between our two offices, we offer and administer all of the ancillary services listed in our letter. We never stated that our physicians interpret each ancillary study. In fact, we have the best cardiologist and radiologist in our respective areas interpret the studies. This type of partnership, borne out of mutual respect, is part of what makes our model of practice work so well. Second, if you buy Dr. Brown’s rationale for choosing a gastroenterologist for colonoscopy, then maybe family physicians should refer every sinus infection to the local ENT. Sadly, Dr. Brown’s assumptions and response reaffirmed our position about his article more than we could have imagined.

I am shocked and offended by Dr. Sanford Brown’s response to the letter from Drs. Grunsky and Capps. Apparently, Dr. Brown has no idea how easy it is to perform a colonoscopy and upper endoscopy in the modern era. Yes, there are still risks, but gastroenterologists think they have an amazing ability that takes months to cultivate when in fact they are merely playing a video game. Twenty years ago, a family physician was qualified to run a flexible sigmoidoscope into the sigmoid colon to the splenic flexure of an unsedated patient. Now that same physician is easily capable of advancing the scope another two feet and making two left turns in a sedated patient. Those of us who played video games as a kid know that it is more difficult to rescue the princess in a game of Donkey Kong than it is to intubate the cecum. And how many gastroenterologists use a screening colonoscopy as a chance to remind the patient to continue exercising or to re-emphasize smoking cessation?