What should I do if my specialist is not proactive in my care and doesn't perform hands-on exams for my conditions, including Crohn's disease, chronic prostatitis, Benign Prostatic Hyperplasia (BPH), chronic pelvic pain, hypertension, and health anxiety?

From the Guidelines

You should seek a second opinion from another specialist who specializes in your conditions, particularly a gastroenterologist for Crohn's disease and a urologist for prostate and pelvic issues, as proper management of these conditions requires comprehensive assessment, including hands-on exams. If your specialist is not being proactive or performing necessary hands-on exams for your multiple conditions, you should first directly communicate your concerns to them, explaining that you feel your care needs more thorough physical assessment. Consider bringing a detailed symptom journal to appointments, documenting flare-ups, pain levels, and medication effects. You might also benefit from requesting specific tests like inflammatory markers for Crohn's (CRP, fecal calprotectin), prostate-specific antigen (PSA) for prostate conditions, and regular blood pressure monitoring for hypertension, as recommended by guidelines such as those found in 1. For complex cases like yours with multiple conditions, a multidisciplinary approach might be necessary, potentially including pain management specialists, physical therapists specializing in pelvic floor dysfunction, and mental health support for health anxiety.

Some key points to consider in managing your conditions include:

• The importance of individualized care, as highlighted in 1, which emphasizes respecting common principles while attending to individual patient characteristics.
• The need for comprehensive assessment, which may involve hands-on exams to identify important clinical information, such as abdominal tenderness in Crohn's disease or prostate abnormalities that could indicate progression of your urological conditions.
• The potential benefits of a multidisciplinary approach, which could include specialists from various fields, such as gastroenterology, urology, pain management, physical therapy, and mental health support, as the management of conditions like chronic prostatitis and BPH may require a comprehensive approach, as noted in 1.

Given the complexity of your conditions, including Crohn's disease, chronic prostatitis, Benign Prostatic Hyperplasia (BPH), chronic pelvic pain, hypertension, and health anxiety, it is crucial to prioritize a thorough and proactive approach to your care, which may involve seeking a second opinion and advocating for the tests and treatments that are most appropriate for your specific situation, as guided by the most recent and highest quality evidence, such as 1, which discusses the clinical presentation, diagnostic approach, and treatment for acute and chronic prostatitis.

From the Research

Potential Actions to Consider

• If your specialist is not proactive in your care and doesn't perform hands-on exams, you may want to consider seeking a second opinion from another specialist 2.
• This is especially important for conditions like Crohn's disease, chronic prostatitis, Benign Prostatic Hyperplasia (BPH), chronic pelvic pain, hypertension, and health anxiety, which require comprehensive care and management.
• Research suggests that patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) may benefit from a multidisciplinary approach to care, including psychological evaluation and treatment 3, 4.

Understanding Your Conditions

• Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex condition that can have a significant impact on quality of life 3, 5.
• Studies have shown that CP/CPPS is associated with anxiety disorder, and that patients with CP/CPPS may be more likely to experience anxiety and depression 3, 4.
• Benign Prostatic Hyperplasia (BPH) and hypertension are also common conditions that require regular monitoring and management.

Treatment Options

• Alpha blocker therapy may be a treatment option for CP/CPPS, although the effectiveness of this treatment can vary depending on the individual patient and the specific circumstances of their condition 6.
• Corticosteroids have also been suggested as a potential treatment option for CP/CPPS, although more research is needed to fully understand their effectiveness 5.

Next Steps

• If you are not satisfied with the care you are receiving from your current specialist, you may want to consider seeking a second opinion from another specialist or a multidisciplinary team of healthcare providers.
• It is also important to take an active role in your own care, by educating yourself about your conditions and treatment options, and by advocating for the care and management that you need.