Saturday, October 22, 2011


I recently became the supervising physician of four ARNP's (Nurse Practitioners).

They are all quite busy and do a great job.

I've noticed that, at times, the word "deferred" is used when a rectal exam was not done as part of a History and Physical, usually on a very elderly patient.

Most of the time, it's not clinically indicated (a palliative or hospice patient, for example).

The problem with the word deferred, however, is that it implies it will be done at a later date.

This is usually not the case.

I have recommended to use one of the following options for "rectal exam" if excluded from the exam:

Not done.

Not clinically indicated.

Patient declined (after being offered).

Reports was done by another health care provider within the last year (especially for folks being followed by, for example, a urologist).

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