Scenario 2, Part 3 of 3

A few months later, Mrs. Owens' PCP diagnoses irritable bowel syndrome. He refers her back to Dr. Piper, noting that "patient does not want scopes."

Dr. Piper documents an "unremarkable" exam and a "long talk about management…think it would be wise to have colonoscopy."

Three months later, a gastroenterologist finds a "near obstructing lesion at 22cm going up to 28cm." Additional tests show metastasis to liver and lungs.

Mr. Owens writes to Dr. Piper accusing him of "incompetence." Dr. Piper writes back acknowledging that he had continued to attribute the symptoms to hemorrhoids, "when, in fact, a new process had developed."

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

Attempted to convince Mrs. Owens to have a colonoscopy.
Documented his conversation about colonoscopy with Mrs. Owens.
Wrote to Mr. Owens.

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

Refer Mrs. Owens to a gastroenterologist himself.
Contact the patient's husband to persuade Mrs. Owens to comply.