Dr. Arpeet Shah
speaker
84 appearances
1 recordings
1 series
first heard Sep 2024
last heard Sep 2024
Dr. Arpeet Shah’s voice in public audio — every appearance, attributed to the second.
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Yeah, so our BPH program is really, I think, robust and I'm really proud of what we've built. It's a combination of utilizing patient navigation services, our advanced practice providers, nursing kind of at every level, and then the physician to drive things home and But we have all new patients are seen by the physician. We really try to make that happen.
I think it starts the patient journey off in the way that a lot of patients want. They want to see a doctor. And then if a patient has significant urinary symptoms based on AUA symptom score, We'll, you know, we'll trial a med if they have not. And then, you know, we really care. And I personally really care about objective testing.
I think the days of saying you have urinary symptoms, we're going to do a TURP are kind of over because we have so many options in terms of the surgical management and all the procedures that are available. And we know that certain procedures work better for certain prostates and certain work better for other prostates. So I am just a huge proponent of objective measuring.
And so objective measurements come with three things, you know, cystoscopy, transrectal ultrasound of the prostate, and then some form of uroflow, urocuff, uroflow, urodynamics, depending on kind of what your practice wants. And we usually start with Eurocuff in our practice. And it's because it's a great non-invasive test that, you know, we don't have to put anything into a patient.
And patients certainly appreciate that to get some baseline measurements. And then, you know, the Eurocuff test is done by our MAs. on a day and then they're interpreted by our advanced practice providers where we've spent a tremendous amount of time educating our advanced practice providers on how to read Eurocuffs. I can tell you A lot of them can read them better than physicians.
I can tell you, Nicole, if I have, sometimes I will ask her, what does she think about a uro cuff to give me a second opinion or a urodynamics, you know? And so education is important there. And then Nicole will read the uro cuff. And if the patient needs that objective testing, it gets put back onto the physician to do a cystoscopy and trust. We'll usually do that on the same day.
And then at that point, we have all kind of the necessary measurements to make an assessment on how the patient is doing with meds, without meds, if they need surgery, what surgery they need, and we can go from there.
Yeah, the reason why we picked telehealth is multifold. So one is patients are already coming in for their UroCuff. To have them come in again, I mean, it's a big burden on taking time off from work. So telehealths are just, they seem more easier for the patient. It's easier for the practice as well, where one of our big limitations is just space, having enough rooms to see patients.
And so you're taking that part of the equation, kind of you're solving it. And then the third point is this allows Nicole a week to review all her Eurocups. And should she have any questions between the time of the Eurocups and when the patient has their telehealth appointment, she can review it with the physician. If the test is not done correctly, we can ask the patient to come and do it again.
So we have a good test and we have good data. And so all of those things kind of really promote a telehealth visit.
I think patients... want to know what's going on, right? And so by giving them their data, by giving them an analogy that they're very familiar with, and then showing them their own UroCuffs, showing them the pictures, showing them their bladder pressures, their flow rates, telling them what's normal, what's not, is really important. We do the same thing with Cysto, right?
Before I do a cystoscopy, I will go through pictures of normal and abnormal bladders and normal and abnormal prostates. And if you can show them what the normal and abnormal are, and then you do the cystoscopy, and you tell them, look at the screen, tell me what you see here, it's very clear to them. And then they're the ones who are saying, well, I need to get something done. I do have problems.
I realize this, and I think it's all about patient education.
Yeah, and this is why when we look at national Medicare data, we see such high failure rates with BPH procedures. It's because we're intervening too late, right? We're intervening when the bladder has already failed.
And to expect that after somebody's in heart failure, if we stent them, that their heart's going to get back to normal is, you know, a very common sense that it's not going to get better just with that. And so early intervention is important.
The other thing, you know, we actually published a study on this is that we looked at all of our patients who are following up, satisfied on medical therapy for BPH. And I think medical therapy works for a lot of people. But we did UroCuffs on them and 62% had abnormal UroCuffs. So, you know, even these are patients who are coming in saying they're satisfied on medication.
So getting that objective data to them is just really important.
Yeah, for our patients, all of our new patients who have BPH automatically get a, through email, text, get a copy of our BPH booklet, which is just an introductory booklet on all of the tests that we have diagnostic, and then a quick blurb, short paragraph on all the procedures that are out there so they can have some early education on it. But really, we wait until the objective is
data is gotten. So until we figure out their size, shape, and flow rates, and then you can introduce the procedures that will actually work, that will benefit a patient. I mean, there's no reason to, you know, offer a Urolift, in my opinion, on, you know, somebody with a very, very large prostate.
And so you don't want to introduce it too early where patients, you know, are tied to a particular therapy that just won't work for them. We don't want to offer, you don't want to, you know, kind of withhold that information either. It's just kind of slowly introducing that concept.
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