Scenario 2, Part 2 of 3

Mrs. Owens continues to experience "intermittent rectal pain and bowel movements usually accompanied by a small amount of bleeding." Two years after her last visit, she tells her surgeon, Dr. Piper, that she has seen a physician in Florida who had told her she has a fissure and who has recommended that she return to Dr. Piper for a colonoscopy.

Mrs. Owen refuses a colonoscopy, but allows Dr. Piper to ligate several hemorrhoids. Afterwards, Mrs. Owens calls to report some mucous discharge. Dr. Piper sees her again, documents a negative exam, starts her on Metamucil, and schedules her for a barium enema.

The barium enema shows "some diverticula, no other lesions seen."

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

Documented what Mrs. Owens said the Florida physician had said.
Found an alternative to colonoscopy to satisfy his patient and diagnose her condition.

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

Request Mrs. Owens' records from the Florida physician.
Insist on a colonoscopy before ligating Mrs. Owens' hemorrhoids.