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The  BRITISH  MEDICAL  JOURNAL   BMJ  2003;326: (14 June)  gave  the floor to the patient, namely to Christopher Reeve and to  doctors who speak about their own case.

Major societal trends over past 60 years   (Patrick Pietroni)

Loss of deference towards figures in authority

Knowledge explosion through popular books, media and internet

Rise of consumerism and focus on patients as customers

Rise in litigation and downfall of doctors as heroic figures

Rise of managerialism that challenges professionnal hegemony

As I completely share these opinions  I made a  paper at the  3rd World Congress on Men's Health  in Vienna (2003, october)  on the subject of prostatic adenomectomies.        

ABSTRACT

PROSTATE  ADENOMECTOMIES  :  A  NEED  FOR   RECONSTRUCTIVE   SURGERY

A true cultural revolution is currently developping : patients demand  more and more  to give their appreciation on medical care.   World celebrities  like Christopher Reeve  draw attention  and famous medical revues  like British Medical Journal  take up the challenge.

First of all,  physicians and doctors  who are patients themselves  dare questioning  ancient principles.

 As an  urological surgeon  who has successfully undergone  an open adenomectomy of the prostate     I wish to emphasize  the too often hidden insufficiencies of adenomectomies  in the state of the art, for open  as  well as cystoscopic procedures.

 Simply removing benign adenomatous tumor  does not restore the normal status.   After the best done operation still remain physiological anomalies :

- absolute loss of ejaculation  and  fertility

- variable loss of  mictional control 

- variable persistence of urgency 

 Experimenting for techniques of  recontruction  of  the prostatic capsule  and  the  bladder neck ,  at the moment of operation  or  later,  would probably  seem more appealing   in the field  of  clinical and surgical research   if men who detain the medical power  were older and subjects  themselves to this kind of incommodities.

At  least this question should be  a matter of discussion in  men's health congresses   i.e.   in  view of personal  health  and scientific knowledge   not in view of  state money cost.

See  the Poster

Christopher REEVE  said :

"A good doctor will really take the time to develop a personal relationship with a patient and  think creatively to come up with the best possible treatment, rather than just following the protocols set by insurance companies  or  the administration of the hospital.  They need to be independent thinkers who are full of compassion.  

"A good patient should learn everything he can about his illness or disability and be willing to try reasonable recommendations and meet challenges that are posed by doctors or patients. A good patient needs to maintain self discipline, so that he can harness his own  willpower and the ability of the mind to affect the body to help the doctors who are trying to use to medicine to affect a cure."

"What I don't like are celebrities who haven't really taken time to study an issue and,  in that way, become a liability rather than an asset"

Dr. Stephen Hempling said to H. Gaze about his own illness and his relationship with colleagues :

 (  BMJ  2003;326:1323-1324 (14 June), doi:10.1136/bmj.326.7402.1323 )

"Some doctors  have an immediate  reaction of  'I am sorry for you,'  and then,  'You're not bad are you—I'd never have guessed.'  To me,  this sounds as if the only way medics can deal with a disabled doctor is by seeing him or her as hardly disabled at all.  

 "Us doctors... are never the same as a patient; we never have the same problems, and we never do things straightforwardly.   We tend to shrug things off and  just get on with it, and that is another thing in the pigeonhole."

 Personal  Opinions

About adenomectomies

" You don't have any disease. You got it into your head..."

If I ever get a cancer in my prostate