Page 10 - CUAJOctober2022

Leveridge

I’m not about to suggest a year of psychiatry training woven into urology residency.
Stay cool. Here are some practical and some pie-in-the-sky ideas. You may have your
own and should spread the word.
• Level up your current counselling skill set. At the very least, compile a local
contacts list for available psychological services. Better yet, include psycholo-
gists and other experts in your CME calendar. Seek out how to ease patients into
the idea that their mind is a conspirator in their problem. This can dramatically
decrease the activation energy of steering patients to their best chances of help.
Training programs, seek out these experts for your half-day.
• Look to your colleagues who have built these skills already. Every “I can’t help
you [there’s nothing a drug or operation will fix]” is a reminder of the gap, and
an opportunity to do a bit better.
• Advocate for (and participate in) multidisciplinary clinics. Learn from the closest
pain clinic, and work to get psychologists and social workers into the fold for
zero added patient dollars. Proximity and access will collapse barriers to care.
• Bake psychological skills development into andrology fellowships. Surgical
management of ED is highly specialized (and hardly the only aspect of the
subspecialty), but why not a 360º approach to comprehensive care of the ED
patient? Our andrology colleagues are perhaps best situated for the multidisci-
plinary clinics noted above.
• Build urologic care into psychiatry and clinical psychology training. There is
an entire untapped space for clinical and academic leadership in treating these
issues. From co-management of the mood and anxiety disorders that so com-
monly involve urinary and sexual effects to deploying the skills of counselling
and cognitive behavioral therapy, there is already a specialty that is expert in
this, but the practitioners and patients remain largely ships in the night.
• Develop a primary care niche in urologic health or men’s health (more to come
in this space some months hence). Our family medicine colleagues also have
an established psychotherapy armamentarium. A post-CCFP year of training that
includes comprehensive management of GU disorders seems another under-
surveyed area of highly valuable terrain.
Step one is recognizing that patients are piling into our clinics with hopes and
expectations of our expertise that we are underprepared to meet. As keepers of GU
health, it feels right and important to bridge this gulf. Let’s assemble some skills and
teammates and get to work on step two.

References

1. Engel WJ. Uropsychiatry. J Mich State Med Soc 1964;63:273-7.
2. Hinman F, Baumann FZ. Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive disease. J Urol 1973;109:727-32.
https://doi.org/10.1016/S0022-5347(17)60526-3

Correspondence: Dr. Michael Leveridge, Department of Urology, Queen’s University, Kingston, ON, Canada; Michael.Leveridge@kingstonhsc.ca

312 CUAJ • October 2022 • Volume 16, Issue 10