Tuesday, December 30, 2008

Nothing beats a good urologist

Dad has a great urologist (Brian Evans, M.D. at Triangle Urological Associates in Durham, NC). It almost makes me wish I had a prostate --- as long as I could still be a girl.

Dad had an appointment with Dr. Evans today. Despite the Duke University Hospital hospitalists ignoring dad's UTI, Dr. Evans got dad all well in that regard.

And let me just reiterate the point that I have made over and over --- with older men, sometimes the only (focus on only) presenting symptom of a UTI is mental confusion.

* God help any older man who is at Duke University Hospital and has a cath jammed in by careless nurses.

* And God please help these men if they become mentally confused or disoriented.

In those situations, the quick answer for the hospitalist (who has no knowledge of the older man's medical hx and certainly will not contact the patient's PCP) is a dx of dementia. And then the hospitalist and the the resource manager will encourage a nursing home (where the older man will be cathed for convenience since he has dementia).

Protect older men. Always rule out UTIs if he is confused and disoriented. And, don't allow the issue to be resolved with the lazy hospitalists' choice - a dipstick UA. Demand (be cranky if necessary) urine cultures.

Remember, hospitalists (at least at DUH) focus on cost containment over patient care and safety. Period. According to DUH hospitalist/resident, containing costs is the reason he was hired.

And, if you live in the Durham, N.C. and need a great urologist -- make an appointment with Dr. Brian Evans.




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