Reinventing care for GI patients

St. Michael’s is a top therapeutic endoscopy centre. One reason: Dr. Jeff Mosko and our health-care teams who innovate to prevent diseases like colon cancer.

Reinventing care for GI patients

Dr. Jeffrey Mosko, a gastroenterologist, is using innovation and education to make the care experience better for endoscopy patients. Here he tells us what St. Michael’s Hospital is doing, and what’s on the horizon, for patients with gastrointestinal disorders, like colon cancer.

What is endoscopy?

Endoscopy is a minimally invasive test where we put patients to sleep and then insert a camera through their mouth, down into their stomach and small intestine, or up through the colon to look around. We can also look through the gastrointestinal tract wall at the surrounding organs. While they’re normally used for diagnoses, endoscopies have become so sophisticated that clinicians can now use them to remove early cancers from the GI tract, unblock blockages in the liver and pancreas, and take samples from the body.

Why did you want to specialize in endoscopy?

I love the technical challenge. I get to make diagnoses in real time and treat complex and potentially fatal disorders (for instance, I can cure people of early cancer), without them needing major operations.

You’re a clinician in quality and innovation in the Division of Gastroenterology. What are you doing to make endoscopy better?

We know that colon cancer is a preventable disease. It arises from precancerous growths that turn into colon cancer if they are not found and removed. While clinicians are pretty good at finding polyps, they’re not always so good at removing them. That’s what I’m working on.

We are attacking this problem in many ways. We’ve set up an expert committee to identify the best treatments for patients, based on the types of polyps they have. We’ve designed a national course on polyp removal. We are publishing our outcomes as the largest centre in the country performing this procedure. In my roles as gastroenterology divisional director of post-graduate education, director of the advanced endoscopy fellowship and co-director of our international course on therapeutic endoscopy, I also teach endoscopists regionally, provincially, nationally and internationally how to improve their techniques.

What area do you feel you’ve had the most impact, and why?

I honestly think it’s teaching. When I teach other endoscopists, either gastroenterologists or surgeons, about new techniques to improve patient outcomes, I can impact more patients that I ever could with the procedures that I do.

What does a good day at work look like to you?

Almost every day at work is a good day. I have an amazing team around me. I’m surrounded by learners at all levels. We learn from each other! And I get to do procedures that are extremely complex or have failed elsewhere. When I can tell a patient they don’t need an operation, or that we’ve cured a problem, or that we can do a minimally invasive biopsy so a patient can get on with the rest of their treatment – the look on the patient’s face is so fulfilling. Being able to help people every day is very special – it’s much more than work.

I imagine there are hard days, too. What are those like?

We work with very sick people, and the pandemic has only exacerbated that. There are extreme backlogs. Patients are presenting with advanced illnesses that aren’t always fixable. So as amazing as it is to help patients with potentially curable problems, there are many patients who aren’t so lucky. I’m often breaking bad and surprising news to patients – young and old alike. And we often end up in very intense situations involving bleeding or perforation. Those days can be emotionally challenging.

What keeps you going?

Keeping in mind our overarching objective, which is to help the greatest number of patients that we can. I’m also very lucky to be able to go home to a loving family. My wife and two girls are a huge source of support. To them, I’m just their husband/dad and they just want to tell me about their day, hug, play and be together.

What does HUMANCARE mean to you?

The main headline is the movement to reinvent the patient experience. And for me, the patient experience is their interaction with their health-care providers every step of the way, from the time they get referred all the way through to their post-procedure care. Our group takes great pride in providing internationally renowned expert care at every step, and we’re always working at doing better. We host live conferences. We learn new procedures. We’re always bringing the latest procedures from all over the world here to Canada. And we’re a centre that does procedures that no one else is doing. That’s high-quality human care. And we’ve been doing that for four decades.

Now, to help patients navigate their journey, we’re partnering with an IT company to design a tool for patients. It educates patients how to prepare for their procedure, reminds them of their procedure dates, and explains which medications to start and stop. Post-procedure, we’ll use AI technology to monitor them remotely for complications and follow-up.

We’re trying to hit the patient journey at all the different checkpoints to make healthcare more human.

What are you looking forward to?

I am always looking to try something new and/or improve upon something we are doing. This week it was collaborating with one of our surgeons to do something never before done in Canada. We are also about to start a trial looking at a new technique to prevent polyps from growing back. We’re organizing our next live endoscopy course this spring where we showcase some of the newest procedures going on across the world. So there’s lots of excitement here as we continue to innovate and lead internationally.

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