Abstract

When my older brother's wife was preparing to deliver her first child, she announced at a family gathering her intention to deliver “naturally,” without anesthetic of any kind. “After all, ” we were told, “women in poor countries do it all the time.”

“That may be,” my brother said. “But why would you want to? After all, you don't get a medal for it.”

This anecdote illustrates the competing philosophies concerning an increased role for unsedated endoscopy (USE) in Western medical systems, especially in the United States. Increasing the number of unsedated procedures has obvious appeal in terms of possible reduced patient and societal cost, and in provider convenience (shorter recovery and less “overhead” per procedure). However, the pursuit of this goal continues to bump against the stubborn problems of patient/physician perception and acceptance of USE. Thus, the timely inclusion in this issue of the Journal of Madan and Minocha's article, “Who is Willing to Undergo Endoscopy without Sedation: Patients, Nurses or the Physicians?”¹ warrants further discussion.