Focus on men's health can strengthen urology, patient care

September 1, 2012

Do urologists consider the possibility that conditions other than strictly urologic problems in men are causing or contributing to their symptoms? And how willing are urologists to coordinate with other physicians when patients' conditions suggest other care is needed?

Urology Times wanted to know to what extent urologists see themselves as a resource for men's health. Do you consider the possibility that conditions other than strictly urologic problems are causing or contributing to symptoms? And how willing are you to coordinate with other physicians when patients' conditions suggest other care is needed?

Richard Pelman, MD, in Bellevue, WA, was involved in the first committee that began putting together an AUA men's health initiative 3 years ago. He says the current effort will improve the visibility of urology.

"Too many men wait until their first chest pain before they see a doctor or wait until they have blood in the stool before they have a colonoscopy."

But Dr. Pelman says if a patient visits a urologist for erectile dysfunction or nocturia and the urologist can see that hypertension, smoking, or obesity may be significant contributing risk factors, an appropriate referral for those issues can be initiated.

Dr. Pelman, also a clinical professor at the University of Washington, says the Men's Health Checklist comes at a perfect time when health care organizations are working to develop coordinated care efforts.

"Health policy promotion makes us a stronger specialty; it also helps our relationship with patients. If we look at the potential of accountable care organizations, this gives us a stronger base as caregivers to be more involved in male care," he said.

"If I see someone for a urologic problem, if they also have a cardiac problem, I have the patient cleared before I do the surgery. Patients come in all the time from the ER with hematuria, retention, and things that they could actually see their family doctor about, but I think the ER docs can get them in quicker to see me than to primary care," Dr. Swofford explained.

"I'll see them, then turn around and call the primary care doctor and send a letter saying, 'By the way, I talked your patient and this is what we need to do.' "

Dr. Swofford, on the clinical faculty at the University of Pikeville's College of Osteopathic Medicine, has long discussed the role obesity and smoking may play in urologic problems, such as erectile dysfunction. He points out that with the Physician Quality Reporting System (PQRS), there are now financial benefits for doing so.

He likes the idea of the AUA checklist and says he doesn't hesitate to contact the patient's primary care physician if he thinks non-urologic care is needed.

"In fact, I even spend time finding primary care doctors for patients who don't have one," he noted.