doctors are like chefs. they all "cook" a bit differently. how one clinician practices does not really imply that others will do the same thing. not doing a physical exam on the first visit is not a violation of standard of practice (sop). i don't know the circumstances as to why this important aspect was skipped but perhaps there was a reason. did you ask? yes i think it would be prudent to exam the patient (carefully) before ordering a colonoscopy. i agree with you. since hemorrhoids tend to be on the outside or near the anal opening he would need to medically justify this more-invasive procedure like a colonoscopy. if you have a family history of colon cancer or if you are over 50 a colonoscopy would be sop.
is it sop for a gastroenterologist to order a colonoscopy for hemorrhoids without doing a physical exam on first visit?