Urologists: Perception is reality in side effect reports

Urology Times randomly contacted urologists across the United States about how they respond to their patients' complaints and concerns about side effects from urologic medications, as well as the types of problems those side effects may create for the physician and the patient.

Several of the urologists say that as much as they would like to believe their colleagues don't ignore patients' complaints, that's not always the case.

"We have a number of medications that have some very common side effects, and sometimes patients will have very unusual side effects we've never heard of," Dr. Anderson explained.

"Then the patient really doesn't get their question answered, especially if the side effect is relatively mild. I might suggest the symptom was probably related to something else, and suggest the patient check with their primary care doctor. But I have heard from my patients that a lot of doctors do just brush off their concerns."

That doesn't really surprise him, he admitted.

"That happens because we have 10 or 15 minutes to see a patient who has a laundry list of complaints. As specialists, we tend to focus on things we can fix. Things we can't fix, we tend to marginalize," said Dr. Anderson, who has been in practice 15 years. "If we had more time, that might be different, but when you're limited by time, you tend to focus on things that relate to your specialty."

However, he adds that just because a side effect may not be common doesn't mean it hasn't occurred.

"I've gotten to the point in my career where I will never tell anyone that their complaint is not from the drug. I may say it's unusual for a particular drug and I'm not sure why they are reacting that way, and whether it's safe to stop the medication or make a change if the side effects are really bothering the patient."

He says that the decision to stop or to change medications often has to be the patient's.

"A classic example is allopurinol for uric acid stones. There really is no alternative. If patients can't take that, the risk of uric acid stones increases. The patient has to decide whether it's worth the side effects or the risk of getting stones," Dr. Anderson said.

Jacob R. Drucker, MD, who is one of six urologists in his group practice in Norfolk, VA, says that when a patient reports experiencing side effects from a drug, he consults with the patient's primary care physician to determine whether the problem is actually related to the urologic medication.

"I need to contact the internist to make sure there's no interaction with any medication the patient is on," he explained. "Often, we don't always have a feel for the patients like their primary care physician would have. Communication is the key. Speak to the doctor who knows them best, as far as their general medical condition."

If Dr. Drucker, who has been a urologist for 30 years, determines that the urologic medication is causing the problem, he sees little choice in the matter.

"Fortunately, in urology, we have multiple tests where we can actually determine the cause of the side effects and make sure it's not a urologic cause. If it is the medication, you have to stop it," he said. "Multiple drugs can cause multiple interactions, and one person may react differently from another."