Do you always refer out if your patient has blood in the stool?

It depends what test revealed the blood in the stool. I don’t trust the Doctor’s Data and BioHealth testing. Many times over the course of my 10+ years of doing this, I’ve seen positive occult blood in the stool on those tests and then I’ve followed up with LabCorp, Quest, or other more conventional lab assays for that. I’ve even referred to gastroenterologists, and in a handful of cases, there have been positive results as well, but in the majority, there are not. I always follow up with an occult blood request from LabCorp. If those are negative and there are no other signs or symptoms of GI bleeding, like anemia, I typically won’t refer out. But if there are signs of that, then yes, generally, I would refer out. In some cases, it could be ​H. pylori [Helicobacter pylori]​ and ulcer; in other cases, it might be inflammatory bowel disease and the patient needs to get scoped to confirm it. But blood in the stool, particularly a dark cold blood and not a fresh kind of bright red blood, which tends to be more from the rectum and hemorrhoids—if it’s a cold blood coming from higher up in the digestive tract, then, yes, we want to refer out for that.