This is basically my job title and description. Not so much a urologist.
As urologists and surgeons, we are super-specialized to deal with the amazing and complex genito-urinary system. I am always amazed and blessed we have so many “organs” to take care of compared to other surgical specialties. When I finish taking care of a patient’s kidney stones, we then deal with the problems of urinary retention they got after surgery. Three months later, we discuss the concerns they began to have with erectile dysfunction (ED). It literally is a gift that keeps on giving, and I feel so lucky to be able to take care of all these aspects of my patient’s health long term.
However, especially as a sequela of COVID, the onset and flooding of patients having an overactive bladder, bladder/pelvic/testicle pain has just exploded. A colleague recently shared the phrase to describe the situation perfectly, “a headache in the pelvis.” This term blew my mind. It originates from the book called A Headache in the Pelvis, by Davis Wise, PhD, who explores this concept further.
As urologists, we are trained with medical and surgical treatments for many conditions.
I can give you medication for your overactive bladder, inject Botox, or place a pacemaker for your symptoms. And they work well.
However, if we miss, or not address the elephant in the room, which is how the mind, the “headache in the pelvis,” is the root cause of the problem, we are doing a disservice to our patients. As urologists, we dread clinic appointments and these types of consult or diagnosis. Still, if we see it as an opportunity to have a great impact or reassure a patient it is not cancer, or they will not die, acknowledge their suffering with the symptom, and deal with the whole patient and not the bladder, it will be transformative.
In Western medicine, this is what we are taught. Treat the symptom and the problem. More so, become super-specialized not only to treat breast problems but to be the mega specialist of the nipple. I mean, we are really specialized in tiny body parts. Absolutely important and has great value but tends to miss the root cause of a lot of suffering because we never venture to find out what is going on with the other parts of the body we are not specialized in or how other ailments are affecting the reason for this visit.
Being treated by a woman physician has its differences. There is data and studies published in JAMA in 2018 showing that patients taken care of by female physicians tend to have lower mortality, lower readmission rates than when taken care of by male physicians. Women tend to spend longer time in appointments than men, and patients tend to prefer women physicians because they perceive we are better at “listening” and tend to have a practice pattern of being fewer prescribers or technicians of surgical skills but listeners.
Why is this important? Well, because it is addressing a root cause of disease and suffering. Without realizing it, we are using a more Eastern type of healing and medicine. We are seeing how the imbalance in their psyche, their stress, their social situation (women tend to learn more regarding this than male physicians) contributes to their suffering and symptoms.
Yes. Likely as women physicians, we will still prescribe the medication or proceed with surgery. Still, we take the first step of acknowledging the suffering by listening and thus truly hearing the patient and building empathy. Empathy is key in true healing.
There is a subset of men that will see women urologists for a reason. They will seek them out and find us. Some of my patients drive two hours to see me even though they have a plethora of fantastic urologists nearby. It is so important to them; they will seek out the 10 percent of urologists who are women.
They will come to talk about ED. Any urologist can give Viagra or probably place their penile implant. However, most of the time, I do not even prescribe anything, and the patient does not want anything in terms of treatment. They just seek someone to acknowledge the emotional suffering that ED is causing them, and they want to feel whole. A man’s erectile function, or lack of, truly will impact their psyche and their happiness or suffering. Just like most men that get a penile implant likely do not even use it, but they are now no longer suffering because in their mind, they are whole again.
I recently heard a great podcast that interviewed a sex therapist. He described how when men get their penile implant, they no longer worry about ED all day, but now they can think about other things in their life and move on. They are no longer broken, but whole again. Knowing the patients’ true fears and concerns is a key step to begin healing, if that is our goal.
If you want to be a healer and not just a prescriber or transcriptionist of medical problems and symptoms, I encourage you, even though it is against our western philosophy of medicine, to listen to the patient and the whole person you are treating.
It may take more time, which is detrimental to the money-centric generating health system medicine has become today, but it will transform you and your patient. It will begin a true path in healing.
So do not be afraid to be a therapist with Flomax.
It will transform you.
Diana Londoño is a urologist and can be reached at her self-titled site, Dr. Diana Londono, on Twitter @DianaLondonoMD, and on her blog. She is one of the 10 percent of U.S. urologists who are women, and 0.5 percent who are Latina and female.
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