Hemorrhoid Banding ‘Red Flags’

Anorectal patients are easily exploited because they all think their problem is hemorrhoids, so they easily accept hemorrhoid banding treatment even though their diagnosis may be something else. In such cases, hemorrhoid banding may not work, may make them worse, and may delay proper diagnosis and treatment. How does a patient know that they are in a place where this can happen? Well here are a few ‘red flags’.

Red flags

• “We are not really doctors but hemorrhoids have been our ‘family business’ for generations”
• “We recently got into the hemorrhoid ‘space’”(code word:$$)
• We charge $2,000 for a service that is covered by MSP
• Your provider took your word for it that your problem is hemorrhoids without critically assessing or considering alternative diagnoses
• Somebody is making money but you’re not getting any better
• The provider is not an MD
• The provider is not a member of The College of Physicians and Surgeons of British Columbia and is therefore not bound by the College’s rules and regulations for the protection of patients
• The provider has not completed a formal 5-year residency in General Surgery or Gastroenterology, and all that it entails
• The provider is not a Fellow (specialist) of the Royal College of Physicians and Surgeons of Canada (FRCSC/FRCPC)
• The provider is actually a family doctor who never had any formal surgical training but saw an ‘opportunity in hemorrhoids’ and recently purchased an electric Porsche
• The provider is an non-specialist MD who has ‘opted out’ of MSP in order to charge patients an unregulated amount and make more money
• The provider does not properly scope the patient on initial visit and during followup visits
• The provider focuses primarily on banding and does not discuss alternative treatments that are not remunerative
• The provider has not considered the other possible (perhaps more serious) causes of your rectal bleeding
• The provider banded you without warning, explanation or your permission
  -The provider wants to band you even though you have pain (banding should not be done in painful conditions, such as an anal fissure)
  -The provider tells you you have the standard three hemorrhoids and therefore you will need three banding sessions. This is an oversimplification of anatomy but ensures the provider of three visits
  -Followup assessment and banding take less than a minute (you are at a banding mill!)
  -The examiner simply inserts a little plastic instrument into the anus and clicks it without actually seeing the band deployed under direct vision (drive-through ‘click-and-go’ blind banding)
  -The waiting room is full of banding patients coming and going like a production line every few minutes (banding mill)
  -The clinic has a financial arrangement with an instrument company or other corporation that may bias the provider toward using a certain instrument or choosing a particular type of treatment
  The provider has banded you three or four times with no improvement and then says, “Sorry, you will need to see a surgeon”.