This episode is an announcement that this podcast is set to close at the end of this month, August 2023.

Thank you so much for listening to these episodes of Urological and to my previous episodes from the Why Urology podcast here on this feed. 

You still have time to go back to relisten to or save the episodes you really enjoyed or found particularly helpful. 

Thank you so much for listening.

Be well and do good.

Thank you for listening to this episode of Urological. 

This podcast is an open ended conversation of ideas and topics that center around the practice of medicine and the field of urology. 

Recently, one of my younger partners asked me the following question, “Todd, do you have a spot?”

IHere is a quote from Stephen King. 

“It starts with this: put your desk in the corner, and every time you sit down there to write, remind yourself why it isn't in the middle of the room. Life isn't a support system for art. It's the other way around.”

I love my spot at a small desk in the corner of my screen porch. I cherish the time I get to spend here. As an introvert this quiet time fills me.

Having a spot is critical to our lives if we are professionals, We need places to be quiet, to think, and to work to solve the world’s problems and even some of our own.

Life does not exist to support our art. Its the other way around. 

As physicians our “art” is medicine. 

Life does not exist to support our practice of medicine. It's the other way around. Our practice of medicine exists to support our lives.

In this podcast we explore topics and ideas center around the practice of urology and the field of medicine. I am a urologist based in Woodbury and St Paul MN.  

Patients ask me all of the time if anything is “new” since their last visit as they try to figure out what options they have as they consider treatment for whatever condition ails them.

This is a challenging question because something is always “new.” There is always innovation, ideas, and new iterations.

Change is constant.

The reason this is top of mind for me is because within the last couple of weeks my partners and I have been exploring and discussing opportunities to innovate within our practice, as well as seeing some significant changes outside of our practice in our local medical community that have the potential to significantly change the way we practice.

And I have lost a lot of sleep because of the expected changes. I am concerned that some of the ideas I have heard are a bit too much, impractical if not damaging to our practice if not executed or navigated properly. 

There are only two responses to innovation, ideas, and iterations. The first response is to be skeptical, to find the fault in the ideas and to figure out all of the holes in the idea and to determine all of the ways in which the idea doesn’t work. The second opposite response is to look at a half baked idea and to say, “Maybe there is something here” and then to build it despite its imperfections

I wonder which of the two I am, a skeptic or a dreamer.

The reason I have been thinking about this is that I have spent a fair amount of time this past couple of weeks shaking my head, skeptical of ideas, concerned about radical change, I see and essentially asking over and over again, “Why? why, why, why?”

I am afraid that as an older physician, one who views myself as starting the last phase of my career, I am too resistant to change, and afraid of the new, the bold, and the crazy.

But I think I should still be dreaming, to see the things that never were and ask, “why not?”  

A picture, they say, paints 1000 words.

Throughout my practice I have tried to draw as many pictures as I can for my patients. I find that the time I spend in the office often drawing complex anatomical relationships for patients pays off for me in the form of needing to talk less and pays off for the patient in an increased understanding. I find a simple picture drawn for a patient along with an explanation is the easiest way to convey complex surgical techniques and anatomy to help patients understand what we do during specific procedures.

The problem is that I don’t draw nearly enough. It takes time and, as I explain to my patients before I start drawing anything, I failed eighth grade art class. My drawings and diagrams would never win any awards, and outside of the context of a clinic visit, probably shouldn’t be shown.

But, I have shown my work to others. There is a YouTube video I have on my YouTube channel of my drawing a hydrocele, a collection of fluid around the testicle. It's an example of the types of drawing I do for patients. You can find that here: https://youtu.be/06euCzs7uAQ

Our job as physician communicators is that same job that any scientist has in communication. Be brief, be clear, be simple. Don’t talk too much. Carve every word so you say exactly what you mean.  Lastly, stealing from the great physicist Albert Einstein, make it as simple as possible, but no simpler.

I understand how my patients must feel when I provide them with a simple drawing, even though I am not a trained artist. The picture remains even though nobody remembers exactly what I said. 

In medicine we deal with seemingly complex things, difficult to understand, stuff that fills textbook after textbook with big, and unfamiliar words. We treat patients with sophisticated lab tests, fancy equipment, and a knowledge that takes years to get. 

But we must remember that doctor means “teacher” and our job as doctors is to teach, instruct, and educate. To do this we must be brief and clear and as simple as possible. 

And a picture often paints a thousand words. I should draw more of them. And so should you. Even if we failed eighth grade art we should hope that our patients leave our office saying, "how can something this beautiful not be right?" 

This podcast is my personal exploration into podcasting and the field of urology, but in some episodes I am blessed with a guest and in this episode we have a great one. 

Tom Bergman is a physician's assistant (PA-C) who works closely with the the urologists within my practice. He has gained special expertise working in kidney stone prevention strategies. 

In this episode Tom and I review 1 what are kidney stones and why do they form, 2. What are some basic dietary recommendations to prevent kidney stones, 3. What are 24 hour urine tests and what abnormalities in the urine do we find and, finally, 4. We briefly review the most common abnormalities on the 24 hour urines and how we treat them.

I think you are going to learn a ton listening to this episode with Tom Bergman. Thank you, Tom, for sitting down for this conversation. 

Basic Dietary Strategies for Kidney Stone Prevention

1. Hydrate
2. Limit Sodium
3. Get enough Calcium in your diet
4. Limit or Moderate Animal Protein
5. Limit High Oxalate Foods
6. Eat Fruits and Veggies

Link to Jill Harris webpage on high oxlalalte foods. 

https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/