Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance. Why do we do this? We offer it as a convenience so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring physician doesn't need our consultative advice for his 50-year-old patient with rectal bleeding. He just needs us to do a colonoscopy. We have a strict screening process in place to verify that these patients are appropriate for our one-stop colonoscopy program. If we have concerns about medical issues or potential informed consent capability, then we arrange for these patients to see us in advance. However, no screening process is perfect. On occasion, someone shows up whom we might have preferred to see in our office first. How should we handle these situations? We don't a
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