In-Reply-To: <[log in to unmask]>
> A few observations on the development of this thread!
>
> What happened to the chaperoning bit?
>
> Apologies for the fragmentation - lost me logarithms :-)
>
> IMHO
>
> Patients don't present with "prostate" symptoms but rather
> symptoms of urinary outflow obstruction.
>
> The findings on PR are not likely to influence one's
> decision to refer for symptom relief.
>
> Surgery is indicated only to relieve obstructive symptoms or
> to prevent or relieve hydronephrosis in chronic urinary
> retention.
>
> PSA does not meet the criteria for a perfect screening test
> but has been portrayed as such by the media and our
> patients (and us) find a normal result reassuring. There is
> no doubt that a markedly raised result will generate an
> urgent appointment.
>
> When one refers to one's matey local Urologist with all
> one's findings, history, exam, Ix, etc. one then finds them
> all reiterated in the SHO's response along with his/her
> intention to repeat most or all and review in x months.
>
> I feel that it is this type of response which does most to
> damage our professional pride. Isn't it much nicer to get
> back a letter like:
>
> "Thank you for referring this chap. I agree with your
> findings and appreciate you arranging the necessary tests. I
> have organised a cystourethroscopy and ?TUR."
>
> As most contributors have written - the management of this
> problem is largely based in the secondary sector but I
> will concede that in the face of minimally disruptive
> symptoms then a normal or benign feeling prostate with
> normal renal function, U/S and PSA might prevent a
> referral for Surgery.
>
> Peter
>
> Dr Peter Wilson The Mockett's Wood
> Surgery
> Medical Manager Hopeville Avenue, St.
> Peter's
> East Kent Doctors On-Call Broadstairs, Kent,
> CT10 2TR
> Kent International Airport Telephone 01843 862179
> Manston, Kent, CT12 5BP Fax 01843 823046
I think the last paragraph of this letter sums up my feelings
exactly. There is a role for "watchful waiting" with a benign
feeling prostate pr, normal PSA and a thorough discussion of the
possible outcomes with the patient. It will avoid a referral.
PRs on two of my patients this year have revealed an unsuspected
prostate cancer-1 in a man with abdominal pain and another with
nocturia.
I seem to remember the phrase "always put your finger in it
before you put your foot in it"
David Lloyd
GP in Harrow
[log in to unmask]
0181 427 2470, Fx:0181 424 0401
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