 [ Symptoms ] is it sop for a gastroenterologist to order a colonoscopy for hemorrhoids without doing a physical exam on first visit [ Disease ] 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 do not 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