Scenario 2, Part 1 of 3

Mary Owens: History

Mrs. Owens, 65-years-old, has a 10-year history of rectal bleeding. She has seen several PCPs who performed periodic rectal exams and sigmoidoscopies (one included the removal of benign polyps) and one hemorrhoidectomy.

Also during that 10 years, Mrs. Owens was referred to Dr. Piper, a general surgeon. He saw her twice for rectal bleeding, and both times found "no rectal or colon problems or symptoms at present." After each exam, Dr. Piper recommended that Mrs. Owens return to her PCP for annual rectal exams and occasional sigmoidoscopies.

During this time, Mrs. Owens came to resist undergoing sigmoidoscopies.

What did Dr. Piper do to enhance this patient's care?

Documented his findings clearly.
Trusted Mrs. Owens' PCP to coordinate her care.
Documented his recommendation for follow up care.

What should Dr. Piper do to enhance this patient's care?

Not over-use sigmoidoscopies if doing so leads to non-compliance.
Not rely on Mrs. Owens' PCP to monitor her condition.