Patient of mine came back for his annual physical. I reviewed last years notes. He had a big problem back in summer of 2011. Told me that he noticed blood in his ejaculate (dont have to go through details....but think about it, pause, get over it and get back to reading the blog). Sometimes common with one episode with "aggressive sex", trauma, blood thinners....but if it recurs, big warning sign for prostate cancer. I did the usual tests for cancer screening in any guy over 50-digital rectal exam and PSA. All ok but didnt feel right about saying "ok, all is clear, see me in a year". (which is really wrong with healthcare-we screen and due to lack of time; if the standard things we check are all normal, the thinking is- what you are doing as a human is ok. In all reality doctors are supposed to be guiding the patient to say, "everything looks good this year but you should add more fiber, cut back on red meat, meditate and walk more". True, some patients say "I dont have time" but then the great docs think of ways to take the individual personalities and adapt a timeline of change to make sustainable habits. I believe it takes a visionary [Andy Weil] to hear, test, plan, see ahead and apply.)
So I reveiwed the note from the specialist. Ooops.....no note sent to me. What the F___? Why dont these guys draft a note or send me a copy of office visit?!?! So I asked the patient to tell me what the doc did. The specialist did the same thing I did, reviewed the blood tests I did ans said "ok, all is clear, no need to follow up". So the patient is still having blood in his semen, no pain, no other problems. Suffice it to say, I didnt send him back to urologist, I did the work up myself: semen analysis, repeat PSA, and called my radiology friends at Northwest Community Hospital and asked if there was a tech in ultrasound who was "very good at sounding the prostate". (just ordering a test at a hospital-you are only as good as the tech doing the proceedure and the radiologist interpreting the images....so if you have a under trained tech, or someone pulled from another department to do ultrasounds that morning, or a radiologist who has 1000 cases to review before a department meeting in 2 hours....you might get a mediocre test that misses things and is reported as "all clear-Normal Results"!!!!)
My patient's work up is under way, luckily I am comfortable with the initiating steps for prostate cancer screening. But the lesson is if something seems wrong....you have to be your own advocate to make sure the entire work up is performed. Don't take the statement; "ok all is clear" as no cancer yet so lets wait until next year to find it....ask for help on how to make intelligent, research supported sustainable changes to a healthier life.
