PDF Male patients ride online wave

July 2019 VOL. 47, NO. 7

Expert clinical analysis. Practice advice. Policy perspectives.

Male patients ride online wave

Novel sites catering to men emerge, along with conflicting views about Internet-based care

MEN'S ATTITUDES TOWARD HEALTH AND THE INTERNET

Lisette Hilton

UT Correspondent

The Internet's impact on people's health care decision-making has long been an unsettling reality. This is especially true when it comes to men's health, where the Internet provides privacy and immediate access to information--even services--to men who are by all accounts reluctant to seek medical care.

The Internet's appeal and doctors' concerns about quality make sense, researchers reported in "Health information on the Internet: Gold mine or minefield?" published in the Canadian Family Physician (2014; 60:407-8).

"Considering how easy it is to Google-search `bad cough,' it is not surprising that many people make an attempt at self-diagnosis

using the Internet before waiting hours in crowded walk-in clinics or emergency departments to consult professionals," the authors wrote. "The flow of information has fundamentally changed, and physicians have less control over health information relayed to patients. Not surprisingly, this paradigm shift has elicited varied and sometimes conflicting views about the value of the Internet as a tool to improve health care."

Having a condition like erectile dysfunction (ED) makes going to the Internet even more attractive, researchers say. Despite the availability of oral medicines to treat ED, men seeking treatment face barriers that lead to undertreatment in the U.S., including reluctance to talk about ED and other sensitive issues, high medication costs, inadequate insurance

See ONLINE WAVE, on page 30

61%

have neglected visiting a physician even when they needed to go

56%

prefer to keep health concerns to themselves

research their symptoms

27% online when first noticing

changes in health consult a physician when

27% first noticing changes in health

Source: Cleveland Clinic MENtion it Survey, April/May 2018 Image: Jackie Niam@Adobe.

Inside

16 MEN'S HEALTH

Impact of poor sleep quality on urologic disease

20 CODING Q&A

Working with a co-surgeon: How should procedures be billed?

38 MALPRACTICE

Not your patient? You can still be sued for malpractice

Q&A STONE DISEASE

Percutaneous access: Principles and best practices

In this interview, Bodo Knudsen, MD, of The Ohio State University Wexner Medical Center, Columbus outlines his step-by-process for obtaining percutaneous access, discusses the ways he reduces radiation exposure during percutaneous nephrolithotomy, and gives his thoughts on how clinicians can gain proficiency with access. For the full article, please turn to page 18

Bodo Knudsen, MD

Prioritizing kidney preservation in upper tract urothelial carcinoma (UTUC):

Are we doing all we can?

The challenges associated with UTUC treatment have created a paradigm where up to 80% of patients with low-grade disease are treated with radical surgery.1 Yet despite the challenges, there is still plenty of clinical rationale to justify prioritizing kidney preservation whenever possible.

"As urologists, we constantly balance cancer risks with the morbidity of our surgery. At times, removing a kidney for low-grade UTUC can be overkill."

-Brian Hu, MD, Assistant Professor of Urologic Oncology, Loma Linda University, Loma Linda, CA

UTUC PATIENTS MAY ALREADY HAVE SIGNIFICANT RENAL IMPAIRMENT AND COMORBIDITIES

A 2017 retrospective analysis of 731 patients undergoing radical nephroureterectomy (RNU) for UTUC found that 50% of patients had preoperative chronic kidney disease (CKD) stage 3.2

Not surprisingly, RNU only accelerates declining kidney function and progression to CKD.3,4

PREOPERATIVE CKD STAGE OF PATIENTS UNDERGOING RNU FOR UTUC2

16%

Stage 1 eGFR 90

34%

Stage 2 eGFR 60-89

43%

Stage 3 eGFR 30-59

5%

Stage 4 eGFR 15-29

2%

Stage 5 eGFR ................
................

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