Announcement

Collapse
No announcement yet.

Prostate anyone????

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Prostate anyone????

    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..........
    Lively debate is encouraged but please respect the opinions and feelings of others.
    Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
    Thank you for contributing to this site.

  • #2
    Re: Prostate anyone????

    Originally posted by admin View Post
    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.

    Comment


    • #3
      Re: Prostate anyone????

      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?
      Lively debate is encouraged but please respect the opinions and feelings of others.
      Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
      Thank you for contributing to this site.

      Comment


      • #4
        Re: Prostate anyone????

        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

        Comment


        • #5
          Re: Prostate anyone????

          Originally posted by admin View Post
          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.

          Comment


          • #6
            Re: Prostate anyone????

            Originally posted by johnep View Post
            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).

            Comment


            • #7
              Re: Prostate anyone????

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

              Comment


              • #8
                Re: Prostate anyone????

                Originally posted by Jill View Post
                I would be very alarmed if my doc's receptionist did this...
                I was, that's the point.........
                Lively debate is encouraged but please respect the opinions and feelings of others.
                Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
                Thank you for contributing to this site.

                Comment


                • #9
                  Re: Prostate anyone????

                  Originally posted by admin View Post
                  I was, that's the point.........
                  And my point is....ITS SHOCKING !!

                  Comment


                  • #10
                    Re: Prostate anyone????

                    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.

                    Comment


                    • #11
                      Re: Prostate anyone????

                      Originally posted by Jill View Post
                      And my point is....ITS SHOCKING !!
                      You are all quite correct of course, and ymdawd is right in saying this happens far too often.

                      A receptionist is only really "qualified" to deal with admin things - appointments etc, so I have over my years as a pharmacist wondered how they have gained so much power. The excellent response from pharout to johnep's question regarding the pharmacology of alpha blockers would obviously go completely over their heads.

                      I used to think the GP's actually approved of this type of thing, or possibly just turned a "blind eye" to it. A conversation with a very angry GP (not aimed at me) changed my opinion slightly. He was livid when I asked him who was giving his staff the powers to carry out tasks way beyond their skill set. His reply was "I don't know, but I will damm well find out".

                      I guess it's possible the odd GP does not know what some of the staff are actually doing in their name. It could possibly be compared to shop staff in the pharmacy selling P meds when you have nipped out for 10 minutes to buy yourself some lunch, even though they know they shouldn't do it. Fortunately this has never happened to me (that I know of) but it can happen to some locums when support staff knowingly disregard the pharmacists (not to mention the law) orders.

                      Thanks to everyone who responded.
                      Lively debate is encouraged but please respect the opinions and feelings of others.
                      Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
                      Thank you for contributing to this site.

                      Comment


                      • #12
                        Re: Prostate anyone????

                        Originally posted by admin View Post
                        You are all quite correct of course, and ymdawd is right in saying this happens far too often.

                        A receptionist is only really "qualified" to deal with admin things - appointments etc, so I have over my years as a pharmacist wondered how they have gained so much power. The excellent response from pharout to johnep's question regarding the pharmacology of alpha blockers would obviously go completely over their heads.

                        I used to think the GP's actually approved of this type of thing, or possibly just turned a "blind eye" to it. A conversation with a very angry GP (not aimed at me) changed my opinion slightly. He was livid when I asked him who was giving his staff the powers to carry out tasks way beyond their skill set. His reply was "I don't know, but I will damm well find out".

                        I guess it's possible the odd GP does not know what some of the staff are actually doing in their name. It could possibly be compared to shop staff in the pharmacy selling P meds when you have nipped out for 10 minutes to buy yourself some lunch, even though they know they shouldn't do it. Fortunately this has never happened to me (that I know of) but it can happen to some locums when support staff knowingly disregard the pharmacists (not to mention the law) orders.

                        Thanks to everyone who responded.
                        I ponder some of these things on a daily basis. I am in a bit of a different situation as I actually work with internists and family practice physicians (GPs in the UK). I see the day-to-day clinic activity. I can personally tell you that prescriptions at our organization are generated and signed by the physicians 80% of the time without looking at the prescription or patient. Our pharmacy technicians are telling patients things they have no business saying. Accountability is declining, in part due to technology! The other issue with physicians is their workload. Our docs each see about 20-25 patients per day and have 20 minutes to see a patient, chart the encounter, remember the formulary and everything we (as clinical pharmacy) tells them. It's honestly too much, so sometimes one can understand why things that shouldn't happen, happen. Docs here delegate authority to their "staff" which include registered nurses, licensed practical nurses and medical assistants. Sometimes the medical assistants tell patients things they shouldn't, however, it goes unchecked due to workload. It's only going to get worse as clinics (surgeries) get busier and busier and information technology makes decision making easier and easier. For example in my system, if a patient requests a prescription that has expired, the pharmacy generates a refill request which subsequently gets sent to the physician to refill via the computerized system we have. He/She then delegates the request to his staff to simply refill without looking at the drug, clincial situation or patient situation. It's great for improving workflow, however, it's catastrophic in terms of potential medico-legal risk. Sorry for the long rant, just trying to explain how things work here. In conclusion to admins response, I think the GPs for the most part, intend to do the right thing. However, there are many things that occur based on systems that they are unaware of, yet ultimately responsible.

                        Comment


                        • #13
                          Re: Prostate anyone????

                          The situation, Pharout, is very similar here, except that 20 minutes for a GP consultation would be regarded as long. Normally it's half that.

                          Many surgeries have notices warning patients that it's one problem per consultation; if you have two problems you need to book a second consultation (which may or may not be at the same surgery session)

                          What is supposed to happen if both are urgent I don't know!

                          However, to some extent twas ever thus! Repeat Rx were often rubbish in my community days 20 years ago. And in my hospital days I often signed 30 or 40 drug purchase orders at a time, and I'm sure anything could have slipped through sometimes.

                          Comment

                          Working...
                          X