Karen Nash is a medical reporter and media consultant based in Monroeville, PA.

Karen Nash

® reached out to 3 urologists (selected randomly) and asked them each to discuss their experience with treating patients who are transgender.

“Males and females both have urological issues; if they have kidney stones, or recurrent UTIs, we treat them. We currently have 1 transgender patient in our practice. It’s interesting because my partner’s brother is one of the top transgender surgeons on the West Coast.

There’s no issue in our practice. I’ve seen transgender patients for urological issues. The only concern is if additional reconstructive surgeries are needed. Those are very delicate and must be done by people specifically working in that arena, because once they’re done wrong, you’ve lost tissue and have less to work with going forward.

Although our practice is in the South, we’ve a very diverse perspective. I’m the senior doc, I’m African-American. The next senior is Vietnamese; the next, Jewish; the next guy is the only WASP; and the younger two, male and female, are Jewish immigrants from South Africa. Whether patients are queer or straight, whether they’re transgender, patients are patients.

Laws restricting transgender care or allowing doctors not to treat transgender patients are based on ignorance and prejudice. I hope most doctors reflect back on their Hippocratic Oath and say, ‘I never asked your permission to treat or not treat; I’m doing the right thing.’

For general urologic problems, we should be well positioned to treat these patients. Unless they have urethral stenosis issues as a complication, then there could be a problem.

In my system, if one were to act in an untoward way toward a transgender patient, there would be a significant problem.”

“Gender or sexual orientation doesn’t matter. It has no impact on the quality of care and compassion they’ll receive from both myself and my staff.

I’m in a rural setting, so we don’t have a large population of transgender patients. But transgender patients shouldn’t feel hesitant to come in for care because certainly any urologist that’s judgmental or unkind, based on that, needs to be taken to task. That’s completely opposite the oath we take. We are not supposed to be passing judgment on people.

States that pass laws restricting care and allowing medical people to restrict care are disgraceful.

This isn’t politics or religion. It’s people’s health and well-being. It’s shameful people should be singled out—and their health care affected—by political or religious views. It’s the opposite of what I thought this country was founded on.

I hope urologists would look past their personal views, any sort of societal pressures to alter the way they treat people, except to maybe improve it, to be more compassionate and provide quality care—not deny care to people who are transgender.

Any doctor who says you can’t make somebody treat someone they don’t want to treat, that’s actually not true. You can’t refuse to treat someone of color; that’s a civil rights violation. It’s not ethical; it’s immoral. Outside your scope of practice is 1 thing, but that’s not what we’re talking about. If somebody transgender comes to you and you don’t approve, you still have to treat them.”

“We don’t have a program specifically for transgender care here at Penn. Some medical schools are ready to train students in transitioning procedures. It’s a difficult arena for several reasons. It requires a multidisciplinary approach: Plastic surgery, GYN, and urology can all be involved. It’s one of those areas where programs will be different every place, depending on who’s interested in doing it.

There aren’t a lot of people training fellows and residents in these surgical procedures. It may also be difficult for institutions to get people experienced with these kinds of procedures.

As for treating urologic conditions in transgender patients, we do that. Most places do. I can imagine your average physician wouldn’t be completely familiar with the anatomy and their condition. That could create hesitation in some patients in attempting to access care for other general urological things.

I occasionally see transgender patients. I don’t really see a lot of hesitancy on their part. They typically ask if I know they’re transgender and familiar with their surgery. I can usually answer yes. With normal communication, there shouldn’t be a lot of hesitancy, especially if the physician has some experience in subspecialty care; I think they can get good care.

I don’t think a transgender patient should have to go to somebody who specializes in transgender surgery if they have a kidney tumor or prostate cancer or something like that.”

Articles

"In my system, if one were to act in an untoward way toward a transgender patient, there would be a significant problem," says 1 urologist.

What’s been your experience with treating patients who are transgender?

® reached out to 3 urologists (selected randomly) and asked them each the following question: How do you make your urology practice staff efficient and effective for physicians and patients?

“I have 7 employees. Communication with your staff is important. I try to have staff meetings every week or so to go over issues and concerns. We don’t just revisit problems that come up. We get feedback from the staff about what they’re doing, and if they don’t think it makes sense to do it that particular way or if I don’t think it makes sense, that’s really important.

I have monthly finance meetings with my office manager/billing person [to] go over all the financial aspects of the practice—the charges, the profit/loss sheets, the outstanding charges. We look at our patient mix and which insurance companies and patients are behaving badly—the full gamut.

I have a research department too. We do the same thing with them but related to clinical studies [that] we’re doing.

I don’t have to do a lot of training in the area of patient relations. If someone is behaving badly or not talking to the patient nicely, we might sit down and have a discussion. To be honest, I almost have more problems with patients treating the staff badly than the other way around, and it’s getting worse. I don’t know if it’s [because of] COVID-19. I’ve been doing a lot of telehealth this year and people are rude and uncooperative and won’t let you talk. It’s kind of disquieting.”

“We have about 10 urologists in 4 office locations and multiple midlevel health care providers. I’m pleased with the people we have working in this practice. I think they do a nice job.

When we consider potential employees, we look specifically for people who are most likely to care about the people we’re taking care of. I think the most important thing is that the staff members need to care. They need to care about the jobs they’re doing and about the patients’ well-being. I think that’s the key factor.

When we interview potential employees, we vet them as best we can, and, hopefully, it’s going to work. It doesn’t work for everyone, and then we have to make a change. I think the majority of people who work here really care about our patients.”

“I try to make everybody understand they’re an important, integral part of the team. I can’t do the work by myself. I have a good scheduler, a good front desk. My staff has to collect the proper data. I tell them to put some brain action into this; they’re not just a companion to walk the patient to the exam room. They must ask questions and fill out the EMR [electronic medical record] properly.

My LPN [licensed practical nurse] is not only a great asset to my practice; she’s sometimes my right [and] left arms. If I forget something, she’s right there with me.

Everybody has to keep in mind that patient care is No. 1. It’s paramount to make sure patients’ questions are answered and there are no loose ends. Everything has to work as an orchestra, with everyone having their proper place in the practice.

People who help me with procedures must be comfortable attending urologic patients. That involves male and female genitalia. If they have issues with that, they won’t be a good fit. Other than that, they must treat people the way they would like themselves or their relatives to be treated. We have to make people feel safe.

Staff need to be properly trained. Urology is a very specific field that not many people are exposed to in their training, so when I have a new employee, I have them shadow either senior employees or me. I like when they have a little notebook and pen in their hands because they should be writing down what they’re doing. I don’t expect anybody to know that at the beginning, but if I’m repeating the same thing after 3 months that I did the first week, then we have a problem. They need to learn as they go along.

I respect someone more when they tell me they don’t understand something and ask me to explain it again, rather than saying ”OK” when they don’t actually know what they’re doing and do it wrong.

This is not like working in a department store shelving your shirts in the wrong cabinet.”

"When we consider potential employees, we look specifically for people who are most likely to care about the people we’re taking care of," says one urologist.

How do you make your urology practice staff efficient and effective for physicians and patients?

® reached out to 3 urologists (selected randomly) and asked them each the following question: How did you cope with the increased stress the pandemic has placed on your life?

“I took the opportunity to focus more on myself since I was not working as hard. I’ve been doing more cardiac workouts and aerobic conditioning [and] some lifting. I reembraced the game of golf. I realized over the past 20 years of my life, my work-life balance is really off. I was doing really good at work and really bad at life.

COVID-19 hit me 2 ways. First, I turned 60. Suddenly, there’s a disease that has nothing to do with how I’ve taken care of myself, that could easily take my life. Two, if I ever retire, I have no hobbies. I kind of embraced self-help [and the] self-awareness effort.

So I focused on me, which was the only thing I could control during the pandemic. [That] meant putting extra effort into making dinner instead of getting a quick meal and going to bed, exercising more, and reading more. [COVID-19 forcing] me to slow down [at] work [has brought] a tremendous benefit: I planned a trip to Florida for golf school. I always wanted to do golf school and thought if I put it off too long, I wouldn’t be able to do it because I’d be too damn old.

The beauty of medicine is that I never felt unappreciated. But as I got older and the pandemic happened, you realize you need to start focusing on yourself. I don’t know if I’m a better person because of it, but I feel better.”

“We had enough faith in medicine to know we’d figure it out and there would be an end to this. What worked best were health care organizations pulling together. Those same principles worked with our families. People rallied together.

I didn’t do counseling but did more with my family. Trying to look at things we really enjoy doing other than work was very helpful.

I have 2 teenagers. It was hard because they’re used to being social. They like hanging with their friends more than parents. It was hard not being in school, doing remote learning. It really affected their social life.

So we went on hikes and did activities with them where we could be socially distanced from people: hikes, movie night, playing cards, interacting more in the house, working in the yard, being outside when we could. We did things we do as a family but made sure we did more of them.

When you’re busy with work and school, you don’t do as many family activities. Here, we did them. When you do fun things with your family, it’s not only enjoyable, but a stress reliever.

The pandemic gave people a chance to reevaluate their values. There were positives. We realized what is important. [You] see changes in people. They’re making time for family and making sure family doesn’t get pushed aside when we’re busy. This may be a resetting of our values.”

“We talked about things that made us fearful so they didn’t chip away at our own mental health. I’m charged with training residents/fellows, another layer of stress: how to train the next generation when clinical work is completely shut down?

To relieve stress, I did things I always do to stay healthy. It was great being outdoors, which was safe. I walked or ran, either individually or with my husband and son.

I’m Christian. People have different faiths and belief systems, and people relied on the sense of peace faith brings.

I focused on what I could control: relationships that were my certainties, exercise, and healthy eating. My husband’s a surgeon, and our child is 13. We walked and talked. It was wonderful getting back to basics and not be pulled in a thousand different directions and to refocus on what really mattered.

With life returning to normal, we miss that opportunity to gather in midafternoon. We realized the most important things are the people you love. If we had each other, we’d be OK. We still try to be mindful of that—eating together at least once a week or walking together and reconnecting—because we want that part to continue. I cooked during quarantine; I love cooking but never have the time. It was delightful to cook and be home around the table. There were many things I will always treasure.

Some good came from this. The best lessons aren’t always taught the way we would’ve chosen. We have to embrace the lesson no matter how it comes.”

Urology Times reached out to 3 urologists and asked them, "How did you cope with the increased stress the pandemic has placed on your life?"

3 urologists discuss coping with increased stress caused by the pandemic

 reached out to 3 urologists (selected randomly) and asked them each the following question: What is your impression of virtual meetings and conferences?

“I haven’t attended virtual conferences; however, our department at [the University of California] Irvine does all our Grand Rounds on Zoom. They usually entail scientific lectures, with outside speakers 2 to 3 times a month.

The only meeting I commonly attend is the Western Section, but haven’t gone since returning to California.

In the past 2 years, I attended a billing conference and the Society of Academic Urologists [SAU annual meeting]. I wouldn’t have gone back to the billing conference so soon, anyway. The SAU went virtual in January, but my clinical schedule had started picking up, so I didn’t want to take time off. If we took time off when the [operating rooms] were opening up for elective procedures, I’d have felt bad about time away from patients, even if we weren’t traveling to attend.

Virtual speakers are good and bad. They serve their purpose—we’re able to look at slides, hear the speaker, take notes on our computer. That’s a convenience I definitely like.

We were actually doing Zoom lectures prior to the pandemic because it’s a way to get nationally known figures to give lectures without having to travel across country for a 1-hour presentation. Obviously, it’s a technique a lot of departments have picked up since COVID-19 to keep the quality up and keep lectures going.

My main complaint about virtual lectures is the loss of camaraderie of seeing colleagues face to face and having casual conversations.

I expect we’ll continue to see a hybrid system in that there will be in-person as well as Zoom lectures.”

“I didn’t participate in virtual conferences this year, although I’ve done a ton of virtual meetings, speaker trainings, advisory boards, but not 1 [continuing medical education] or AUA [American Urological Association] meeting. I’m one of the senior physicians in our organization and have both clinical and system-level responsibilities. When COVID-19 hit, my responsibilities grew. I’m also cochair of our new system-wide Cancer Center of Excellence.

We did most hospital-system meetings virtually. After the pandemic, I hope we incorporate that into our operation because Houston is a very spread-out city—54 miles across—and we have 13 hospitals. When we had a system meeting, we’d have it centrally and everybody had to drive there. But attendance at virtual meetings is through the roof because everybody participates. Even if they’re in the [operating room], between cases they go to the doctors’ lounge and sign in. People are actively engaged in the discussion. Sitting in their office, people don’t feel threatened chiming in and giving an opinion. Meetings also start and end on time because we’re not waiting for stragglers. I would find it deleterious to eliminate them after the pandemic.

AUA meetings could become a hybrid for a couple reasons, [such as] revenues involved for the convention centers, the hotels, and vendors. Secondly, certain things can be harder to do virtually. Vendors find it harder to demonstrate their products.

On the other hand, we had a list of big group courses and some were at the same time. They can video everything, so later you watch whatever courses you missed.”

“I just attended the Society for Benign Prostatic Disease [virtual meeting], and maybe a bit of 1 or 2 AUA [American Urological Association] meetings.

It’s a good way to access the general content, probably easier than being there in person, in some ways. For a plenary session or something, it’s just as good, if not better, to do it virtually—having the slide right in front of you while you’re sitting at a desk. It’s easier to take notes on your computer and to look things up while you’re watching.

I certainly miss interacting with colleagues, talking to people about new ideas and new practices. The industry portions are less useful virtually than in-person where we can walk around the booths and see new products and talk to people from the companies.

In smaller breakout and poster sessions that have more Q&A, you get less out of them virtually.

Post pandemic, I would like to see a return to in-person meetings. They’re more engaging overall. Being able to interact with your colleagues is better in person. Portions of the meetings could be done virtually in a very effective manner, which might help with the space considerations. They might have combination meetings where some content is virtual, and some is in person.

I think they’ll offer content virtually for people who might not be able to travel easily for logistical reasons having nothing to do with the pandemic. People who can’t go to every meeting but would still like access the content.”

"My main complaint about virtual lectures is the loss of camaraderie of seeing colleagues face to face and having casual conversations," says one urologist.

Karen Nash

Articles

What’s been your experience with treating patients who are transgender?

How do you make your urology practice staff efficient and effective for physicians and patients?

3 urologists discuss coping with increased stress caused by the pandemic

3 urologists share their impression of virtual meetings and conferences