Prostate anyone????

[admin]

Yesterday a man in his fifties asked for a quiet word with me. I took him into the consultation room and we chatted for a while. His experience that day was as follows.......

He had been having "water-works" problems, and had gone to his Dr's surgery to get an appointment with his GP. The receptionist - I checked it wasn't the nurse, no it was the receptionist - asked him what his symptoms were. He told her (as he told me) he was: -

1. Feeling like he wanted to go the the loo to urinate a lot, even during the night

2. He found it difficult to pass water when he tried, and was straining a lot

3. He was getting some pain from this, from his lower abdomen

She told him he didn't need an appointment, and he should call back later that day with a urine sample. The receptionist then "put one of those sticks in it" and told him there was nothing to worry about, he didn't have an infection, and didn't need to see the doctor. He left the surgery.

He then came to see me as he was still concerned. He asked me all the obvious questions you have all probably heard many times before, so I won't bother to list them.

I obviously suspected a prostate problem (BPH etc) and told him a few things, one of them being to make sure he did see his GP - whatever the receptionist said.

I still get a slight shock with this job from time to time..........

[pharout]

Yesterday a man in his fifties asked for a quiet word with me. I took him into the consultation room and we chatted for a while. His experience that day was as follows.......

He had been having "water-works" problems, and had gone to his Dr's surgery to get an appointment with his GP. The receptionist - I checked it wasn't the nurse, no it was the receptionist - asked him what his symptoms were. He told her (as he told me) he was: -

1. Feeling like he wanted to go the the loo to urinate a lot, even during the night

2. He found it difficult to pass water when he tried, and was straining a lot

3. He was getting some pain from this, from his lower abdomen

She told him he didn't need an appointment, and he should call back later that day with a urine sample. The receptionist then "put one of those sticks in it" and told him there was nothing to worry about, he didn't have an infection, and didn't need to see the doctor. He left the surgery.

He then came to see me as he was still concerned. He asked me all the obvious questions you have all probably heard many times before, so I won't bother to list them.

I obviously suspected a prostate problem (BPH etc) and told him a few things, one of them being to make sure he did see his GP - whatever the receptionist said.

I still get a slight shock with this job from time to time..........

These symptoms along with increased urgency to urinate, e.g. cannot wait until he can get to a restroom, and decreased stream are classic symptoms of benign prostatic hyperplasia (BPH). It is probably good to rule out a urinary tract infection, however if no burning sensation on urination and no posterial flank pain, it is probably unlikely. A urinalysis with negative bacteria and leukocyte esterase would rule this out pretty easily. Not sure why you are shocked, you should hear some of the things patients tell me. This pt simply needs an alpha blocker (most cost effective tx) or tamsulosin trial and will probably find improvement in a relatively short period of time.

[admin]

These symptoms along with increased urgency to urinate, e.g. cannot wait until he can get to a restroom, and decreased stream are classic symptoms of benign prostatic hyperplasia (BPH). It is probably good to rule out a urinary tract infection, however if no burning sensation on urination and no posterial flank pain, it is probably unlikely. A urinalysis with negative bacteria and leukocyte esterase would rule this out pretty easily.

Yes I know...........

Not sure why you are shocked, you should hear some of the things patients tell me. This pt simply needs an alpha blocker (most cost effective tx) or tamsulosin trial and will probably find improvement in a relatively short period of time.

You are not sure why I am shocked that a RECEPTIONIST took this upon herself, "diagnosed" his problem, did her own urine test on him, and sent him away telling him he was alright.

If this is common practice then maybe you should give some of your examples of what patients tell you. Or do receptionists now have the power to do this now?

[johnep]

Yesterday got a script for indoramin for a lady. First checked in BNF and it can be used for hypertension. Checked with lady and that was exactly what it was for.
OK you pharmacologists, what does an alpha blocker do exactly?
johnep

[pharout]

Yes I know...........


You are not sure why I am shocked that a RECEPTIONIST took this upon herself, "diagnosed" his problem, did her own urine test on him, and sent him away telling him he was alright.

If this is common practice then maybe you should give some of your examples of what patients tell you. Or do receptionists now have the power to do this now?

Admin,
Sorry, I didn't see that the receptionist dx'd the problem, read through too fast. I thought she had simply asked what his symptoms were. In our system, they do do that so that they may triage calls/appointments, etc. However, that's where it stops. I completely agree with you that the rest would be inappropriate.

[pharout]

Yesterday got a script for indoramin for a lady. First checked in BNF and it can be used for hypertension. Checked with lady and that was exactly what it was for.
OK you pharmacologists, what does an alpha blocker do exactly?
johnep

Johnep,
I'm not a pharmacologist, but I'll take a stab. An alpha-blocker (not sure which generic this is offhand?) dilates the peripheral vasculature, thus leading to a decrease in systemic vascular resistance. In terms of blood pressure reduction, this is how it works. It does not block the alpha receptors selectively and also targets the prostate, which is why it is used in men for this reason. There are several alpha-blockers on the market indicated for the treatment of HTN. None of these, however, are indicated (per HTN guidelines) as a first-line choice for this. Not even second or third line. This would also hold true for the British Society of HTN and European Society of HTN guidelines as well. It should ideally be used in cases where a patient is already on several agents for HTN and still uncontrolled (resistant HTN).

[Jill]

I would be very alarmed if my doc's receptionist did this...

[admin]

I would be very alarmed if my doc's receptionist did this...

I was, that's the point.........

[Jill]

I was, that's the point.........

And my point is....ITS SHOCKING !!

[ymdawd]

Shocking it most certainly is but surprising..NO.!

Most community pharmacies could probably come up with similar occurences. I can think of a couple of cases today where prescriptions were blindly generated again after first being issued a couple of days previously. Clearly the surgery does not check its records properly, if at all. That alarms me greatly because it happens so often. Best practice - you must be joking. How can it be when they show a complete inability to learn from their errors.

I have often tried to reason with GP's & surgery staff about this but to no avail. Simply put they do not see it as a problem. What is more they will get away with it too. I pride myself on knowing when I am hitting my head off a brick wall.