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Expert: Clinicians must understand biases when offering stone treatments


"The biggest take-home message for any urologist who's treating kidney stones is to understand that what we consider to be success may not be what our patients consider to be success," says John Michael DiBianco, MD.

In this video, John Michael DiBianco, MD, shares the take-home message from the recent Journal of Endourology paper, “Development of a Surgical Decision Aid for Patients with Nephrolithiasis: Shockwave Lithotripsy vs Ureteroscopy.” DiBianco is an assistant professor of urology at the University of Florida, Gainesville.


What is the take-home message for the practicing urologist?

The biggest take-home message for any urologist who's treating kidney stones is to understand that what we consider to be success may not be what our patients consider to be success. [It's also important to] understand that what our final recommendation is to our patient holds an incredible amount of weight with them. Therefore, it's even more important to understand what our own biases are when it comes to which procedure we offer them. Things like utilizing a questionnaire or a pamphlet or some sort of tool to understand the patient goals of treatment, and to allow that to guide the conversation in an accurate and practical manner, is likely very beneficial for both patients and for quality care.

Is there anything else you would like to add?

I utilize it currently. I'm in a little bit of an interesting scenario where a lot of my patients here at the University of Florida tertiary care center are not typically candidates for shock wave lithotripsy, so I'm not actually using it as much as I thought I would. But it makes sense to me that for the majority of practicing urologists who are treating kidney stones, potentially having a tool like this to help guide that conversation would be very useful. We're not the first people to be doing this. I have to give a shout out to Manoj Monga, MD, who, along with a lot of others, have studied this area pretty extensively. They were very helpful and their results have been very helpful. There are many others who helped us along the way, such as Giulia Lane, MD, who is an assistant professor of urology, and Sarah Hawley, PhD, MPH, who's a professor of general medicine. These people were incredibly helpful in an arena that urologists are typically not on the forefront of when it comes to patient-facing material. Without the effort of this entire group, our patients, patient advocates, and the whole [Michigan Urological Surgery Improvement Collaborative] community, this wouldn't have been possible.

This transcript was edited for clarity.

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