Telemedicine and Rectal Chief Complaints

Telemedicine encounters for parts of the body the patient can’t see are problematic—none more so than problems with the rectum.



Don’t assume any rectal problem is simply hemorrhoids—even if the patient identifies it as such.



Fissures, fistulae, undiagnosed IBD are only a few of the problems that it’s not uncommon to miss.



And don’t let the patient try to bully you into the use of video encounters to try to increase the accuracy of your diagnosis. You know you need palpation to make the right call.



Because of the difficulty patients have in monitoring the area, telemedicine for this chief complaint is a higher risk encounter than others as well.  Things can quickly go very bed before the patient reaches out for a follow-up.



Have a very low threshold for directing these patients to an in-person evaluation—at a level of urgency consistent with acuity. But always sooner rather than later.



Once you explain why, you don’t usually get much push-back.