How Is Our Practice Unique?

“People often ask me, ‘Why is your practice unique? How are you different from any other practice that’s a Men’s Health practice or is a Sexual Medicine practice?’ I think there are several things. One is, if you look at, for instance, myself, and the head advanced provider, Ken Mitchell, who happens to be a physician assistant, between the two of us, we have about 50 years’ experience in just doing Men’s Health and Sexual Medicine. So I’ve been doing this for a long time.

We have a staff that is really not only very trained, they’re very experienced. They have been doing this for a number of years. They’re actually hand-picked by us from our other practices, and they have joined us here. So we have a very experienced staff.

The other thing is, my focus is really on how I can evaluate and fix the underlying cause. I think that’s the key. I can certainly treat your sexual medicine condition, that is not the difficult part, and I have a whole spectrum. But, what is the underlying problem? Because maybe I can address it with lifestyle, with nutrition, with exercise changes. Maybe you need pills, maybe you need both for a while, and then you can go back from one to another. But we really focus on identifying the underlying cause, addressing that, and usually that means addressing it with our other colleagues, either in Primary Care or a specialty that we refer you out to, while we focus on the Sexual Medicine condition. So when I look around at what’s out there in the country right now, I think that we do have a unique focus.

We think it’s a very precise, personalized approach to Sexual Medicine and Men’s Health.”

Working with Primary Care Colleagues

“An important part of men’s health is really working with other providers in the community. One of the most important providers would be our Primary Care physicians, just because they’re really at the center of everything. They’re at the crossroads. They pick up a lot of these problems. So, I always say it’s a two-way street, because what I do on the Sexual Medicine end is something that. . . It’s not that they couldn’t do it, it’s just that they have a lot of other things to do. Our practice is focused on this. This is what we really are streamlined to do. So I found a lot of times they’re very happy to have a place where they can refer their patient to, to manage their, say, erectile dysfunction, low testosterone, some of the other Sexual Medicine conditions that we work with.

One of the things I always tell them is that we fully appreciate what they do as a Primary Care physician because I know, for instance, erectile dysfunction does not occur in a vacuum. So I fully understand that when I pick up, or if a patient has diabetes, high blood pressure, high cholesterol, if they aren’t managing these other conditions well, that my treatments are not going to be as effective.

And quite frankly, they may need to go on that injection when they could be on a pill. So, I am very, not only interested, but look forward to working closely with my Primary Care colleagues because, one, I know that if men come in to me first, I’m going to pick up things that will need referral to a Primary Care physician, and I also think that I can help them with some of the issues.

So, one of the things that we stress is just communication back and forth, and that has worked very well for me in the past when I was in Maryland and I’m looking forward to getting to know the Primary Care community here in Nashville.”

Collaborating with Urology Colleagues

“I am a Urologist by training. So I went to Johns Hopkins for my residency. I did a fellowship after residency, where I specialized in Sexual Medicine issues, and blood flow-related issues. I have a physician assistant who’s working with me, Ken Mitchell. He also is a fully trained Urology PA. But initially, Ken started in Family Medicine, so his core is Family Medicine, but he then worked with a Urology group, so he’s a fully Urology-trained PA who also specializes in Sexual Medicine. I know Urology in and out.

For the past 20, 25 years, my practice has focused on Sexual Medicine. So I did mostly the medical side of erectile dysfunction, low testosterone, I did Peyronie’s and I did the medical management for the BPH that we see.

Many times in my Sexual Medicine practice I pick up a lot of General Urology concerns. I’ll pick up men that have elevated PSA’s. Whether you just pick them up, or with testosterone therapy, they need to have a prostate biopsy. I would refer those to my colleagues who did General Urology. We often times will get to the point where the medical management for the BPH just wasn’t adequate and the men needed additional therapy, and those were actually referred in. So, even though I’m a Urologist, my area of interest is very focused and niched at this point, so that General Urology really becomes another referral for me.

And so, I spend a lot of time talking with my colleagues. One, because I’m going send a lot of things out to them and I want to have a very smooth exchange. And the second thing is, many of them are quite busy with General Urology and they’ll send some of the erectile dysfunction issues that they want to send to me.

I’m very happy that I trained as a Urologist, I think it’s given me a very unique perspective on my Men’s Health, Sexual Medicine career now.

I also in the past, the surgeries I used to do, I used to do a lot of penile prostheses surgery. I do not plan to that because we’re really focused on setting up a medical management type program. But again, from a Urology perspective, having done these surgeries, I know exactly how to work these men up. I know that having a prosthesis at the right time is an excellent treatment option.

And so, really what I’m looking for in my Urology colleagues, somebody who I like and trust, so when I refer people I know they’re getting good care. It’s not really a matter of, ‘Will I be referring? It’s more finding a like-minded provider that we can work together, so that the patient will get overall the best care.”

Post-Prostatectomy Penile Rehabilitation

So post prostatectomy, we know that men can have problems with incontinence and they can have problems with erectile dysfunction. I’m really fortunate to have Ken Mitchell, who’s the PA who’s here with me. Ken developed really one of the leading penile rehabilitation programs for post-prostatectomy surgery and he’s gotten great results in working with these men.

So one of the things that we really want to offer the Urology community here is, when you’ve done the surgery. If you’re looking for somebody to help manage the post-prostatectomy problems with erections, incontinence. I’m talking about the non-surgical approaches, because I know that if they need an implant, then the practice will probably want to do that. But just for the rehabilitation phase, we are actually very well set up to do that. And that’s an area where I think, where I believe that there’s a lot of room for exchange and working together.”

Our Work with Colorectal Surgeons

“One of the groups that I’m very excited about working with are Colorectal surgeons. And it’s interesting. This is something that probably should have been more apparent to me a long time ago, but if you look at the surgeries that the Colorectal surgeons do, they can impact the nerves that cause erections in very similar ways to what we do when we take a prostate out. Many of their men who have bowel surgery or rectal surgery can develop erectile dysfunction. Especially if they’ve had any ED before the surgery, the surgery can make it worse or they can develop it after the surgery.

I was actually at a meeting. It was an erectile dysfunction meeting and there was a Colorectal surgeon who was there and so I just said, ‘Hey, what are you doing here? What are you thinking about?’ And when we started talking I said, ‘Boy,’ I said, ‘A lot of your men probably have erectile dysfunction.’ He said, ‘Yes, they really do.’ So we just started talking and we struck up a great relationship and I’ve gotten a lot of referrals along that pathway.

And certainly, if I pick up any erectile cancer problem with that, I would send into them. But, I think for the Colorectal surgeons, erectile dysfunction is a very common problem that they can face after their surgeries. So I think for them it’s very nice to have a place where you can send the patient to have this issue addressed. So that’s another very pertinent and relevant referral pattern that we hope to get to know the Colorectal surgeons here in Nashville.”