I have reached an age where urinary infections are impacting on my quality of life. But my recent experiences with managing the problem has highlighted inconsistency in the urology expertise of the NHS.
I have been troubled for many years with Urinary Track Infections ( UTI ) because of an enlarged prostate. After a particularly bad infection which developed into Prostatitis I was put on a bag catheter and then eventually moved onto Intermittent Self Catheterisation ( ISC ) to reduce the risk of any further UTIs.
My story starts with two consultants at different hospitals. Let me label them consultant A from the Urology Department in one hospital and consultant B from the other hospital. After recovering from Prostatitis an appointment was made with consultant A for further tests and to discuss the best way to manage my health problem. When I met with consultant A he advised me to stop using the catheters. Life settled into making sure that I was drinking enough water and carefully marking out the location of public toilets! The situation was tolerable and I was beginning to feel that this was the new normal. When I left the consultant I made an appointment to review the situation in six months time however the hospital cancelled it closer to the date. When I hadn’t received a date for an appointment I contacted the hospital’s help line to be told that they hadn’t forgotten about me and I was still on the waiting list. After about 18 months and with no signs of an appointment with consultant A I discussed the situation with my GP and asked to see another consultant who had helped me in the past and I was switched to consultant B. I received an appointment within a week and if I hadn’t been travelling abroad I would have seen him before the month was out. Two long haul flights later and I came down with a bad UTI which required 3 weeks on antibiotics by which time I was on my way see consultant B. In consultant B’s Urology department I we went through a series of tests and a questionnaire about how the medical problem was affecting the quality of my life. During the consultation I explained what had happened over the last few months and then consultant B explained that I had been sitting too long and should have used my catheters. He then went on to explain why I needed to use the catheters for the rest of my life and how they ensured that my bladder was emptying. When I was leaving I asked if he wanted to see me on a regular basis for example annually he replied that that would not be necessary because he felt that I was competent enough to manage the situation.
Under the new catheter regime looking back I realise that I probably had a low level urinary infection since I saw consultant A. I now feel a lot better and the inconvenience of using the catheters is insignificant when compared to the improvement in my quality of life.
Looking back over my experience with both consultants I realise that I had assumed that the level of expertise of urology consultants across the NHS would have been approximately the same. I say ‘approximately’ because I realise that due to the complexity of the human body and we all have different medical histories. However, I felt that my condition was not uncommon in older men and therefore the diagnosis and medical support should have been the same.
So what could have contributed to the difference in advice? Lack of resources between the two hospitals could have contributed to the difference in advice with consultant A not having enough time to analyse the test results and have an in-depth discussion. There could be a wider issue of the organisation of Urology departments which are under increasing pressure from changing employment contracts, a challenging on-call system, changing training requirements as well as the increasing threat of litigation. All of these factors could have contributed to the difference in advice. However, I think that the difference comes down to the approach. Consultant A viewed my medical problem as a problem where he prescribed the appropriate solution a bit like a mechanic fixing a problem on a car. Consultant B looked at the problem from the patient perspective and by increasing my knowledge of the underlying problems and taking the time to explain why the course of action would improve the situation. Consultant B took a patient centric approach where I was seen as part of the solution.
I remember listening to a surgeon on the radio where he said that curing medical problems boils down to two approaches: medicine or surgery. We automatically think that medicine comes in a bottle or a tablet, but it could come in the shape of knowledge, and it is how it is applied that makes the difference.
Big thanks to the Nurse who helped me overcome my fear of inserting a catheter as well showing me a few ‘tricks of the trade’, both urology consultants and their staff and my GPs for their on-going support.