#cuajc - Twitter Hashtag

Canadian Urological Association @CanUrolAssoc

over 5 years ago

Keep your #CUAJC comments coming! Thank you to our host @_TheUrologist_ Thank you to our contributors tonight! @JDCampbell_MD @HeatherEm3 @RyanFitzUro

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Canadian Urological Association @CanUrolAssoc

over 5 years ago

Great chat team! Huge thanks to the authors @Witherspoon_uro @ham_neg @ChamplainEthics for their insights, and to all for joining! That’s a wrap on #cuajc!

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Mike Leveridge @_TheUrologist_

over 5 years ago

@CanUrolAssoc A10 I wondered if others might have said along the way “are you sure he’s capable of consenting? What are you *doing* to him”. I imagine the trust built by the urologists among their colleagues helps decrease friction and ensure confidence #cuajc

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Luke Witherspoon, MD | Urologist @Witherspoon_uro

over 5 years ago

@ChamplainEthics @CanUrolAssoc This might be the most important thing to learn from tonight!! Help is out there. #CUAJC

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Luke Witherspoon, MD | Urologist @Witherspoon_uro

over 5 years ago

@ChamplainEthics @CanUrolAssoc A8. One question I had for @ChamplainEthics , if a community hospital had an ethics issue, do you think they could call a tertiary centre to access your opinion? #CUAJC

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Ryan Fitzpatrick, MD @RyanFitzUro

over 5 years ago

@CanUrolAssoc A9 Depends on patient goals. If possibly a candidate for chemo or other treatment in the future, then renal preservation with decompression (NTs) If they are truly palliative then minimize interventions. Sometimes may need decompression if pain predominantly from hydro #CUAJC

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Mike Leveridge @_TheUrologist_

over 5 years ago

@CanUrolAssoc A9 so common; requires #CanMEDS #communicator skills with patient/advocates + #collaborator skills with referring colleagues to alert about risks of cannonballing into an existing doctor-patient relationship #cuajc

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Mike Leveridge @_TheUrologist_

over 5 years ago

@CanUrolAssoc A8 this gets a yes, and will leave it at that. Always challenging, frustrating and at times sad. Reminders to do some thinking about the process to improve #cuajc

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Jeff Campbell, MD, MPH @JDCampbell_MD

over 5 years ago · London

@CanUrolAssoc A5: I will often bring them back for another discussion a few weeks to months later in case they change they mind. Sometimes it helps to refer for a second opinion as well. If necessary (cancer; uropathy etc) to follow I will. For QOL surgery the can call if needed #cuajc

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Mike Leveridge @_TheUrologist_

over 5 years ago

@CanUrolAssoc A7. Sometimes it’s a safety/feasability issue that needs better communication. Also in this case the surgeon’s wisdom/knowledge take primacy #cuajc

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Luke Witherspoon, MD | Urologist @Witherspoon_uro

over 5 years ago

@CanUrolAssoc A7. Assuming there isn't immediate danger I think the "second opinion" consult of a colleague is the best solution. We don't love getting them but I think they are extremely useful. #CUAJC

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ChamplainEthics @ChamplainEthics

over 5 years ago

@Witherspoon_uro @CanUrolAssoc Agree with this. Patients have a right to know all of their options that could be beneficial in order to make an informed decision about that corresponds to their own personal values #cuajc

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Jeff Campbell, MD, MPH @JDCampbell_MD

over 5 years ago · London

@CanUrolAssoc A6: I think this is actually a big problem. Both cognitive function but also language. Even with interpreters a lot of information gets lost in translation. These are instances where “tell me what you understand” or repeat back to me is essential! #cuajc

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Luke Witherspoon, MD | Urologist @Witherspoon_uro

over 5 years ago

@CanUrolAssoc A6. Another important aspect is that we may play a part in them "refusing" an option if we don't offer it in the first place. I certainly get the feeling "oh this guy wouldn't want this" due to age/etc, only to be surprised by their response. #CUAJC

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Jeff Campbell, MD, MPH @JDCampbell_MD

over 5 years ago · London

@Witherspoon_uro @_TheUrologist_ @CanUrolAssoc Yes. Also with long wait times with COVID backlog. Patients have often changed their mind... or forgotten what the surgery really entails #cuajc

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Hamidreza Abdi

@ham_neg

over 5 years ago

@CanUrolAssoc A6. I think it is always reasonable to involve someone else in this scenario, like allied health care and/or family members and document the discussion. #CUAJC

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Mike Leveridge @_TheUrologist_

over 5 years ago

@CanUrolAssoc A6 using your clinical acumen to suss out understanding is important. Altering tone/complexity, asking for repetition, stopping to summarize etc are hedges against bafflement #cuajc

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Luke Witherspoon, MD | Urologist @Witherspoon_uro

over 5 years ago

@CanUrolAssoc Q7. More often than we think. I can think of a few instances even recently where terminology/patients understanding of a procedure/etc led them to decline therapy that upon further discussion they did indeed want. #CUAJC

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Mike Leveridge @_TheUrologist_

over 5 years ago

@CanUrolAssoc A5 when the stakes are higher it can be frustrating of course. In cancer cases it usually presupposes a deterioration on the horizon if untreated. Make a plan and articulate the expected future, then prep to refer in a timely manner #cuajc

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Mike Leveridge @_TheUrologist_

over 5 years ago

@CanUrolAssoc A5 there are some softball versions that might inform practice. Think AS for GG2 cancer if we recommend Tx. Still support the patient and follow #cuajc

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