Beyond the Scope – October Edition # 1

As healthcare professionals, the traditional expectation remains unchanged: work beyond your emotional and physical capacity.

Put simply — do more than what you can.

But it raises a deeper question — what exactly is the limit of “can do” for a doctor?

Like it or not, we all live within the same 24 hours a day, 168 hours a week. A typical working day stretches around nine hours, six days a week — and that’s before on-calls begin.

As a trainee, being rostered for in-house on-calls means staying overnight or through weekends to ensure continuous patient care. Reality in practice— someone has to be there.

Yet, with three to four on-calls a week, the maths is brutal. The total easily climbs to 80–85 working hours.
Is it sustainable? The reflex answer we hear is familiar

— “everyone’s done it, so why can’t you?”

You risk being branded lazy and selfish, if you dispute it

In reality, every extended work hour takes away an hour from personal habits, ambitions, and family time — slowly chipping away the reserves of emotion that, in my view, are the core commodity in delivering patient care.

Care delivered without emotional empathy is meaningless.

I have been on the other side of the table, like most of us. I don’t remember how expensive my healthcare was or how skilfully my operation was performed. What stayed with me were the words spoken to me by those looking after me.

To be a doctor is to be emotional about patient care. But emotions are not an unlimited resource. Each extra hour we give to the system without recovery steals a small piece of that resource, until one day, the well runs dry.

— Mudassir Hussain, FCPS, FRCS (Urol), Editor

Where do you think we can make the greatest change in UTI management?

• Preventive strategies — 64% ✅

• Patient education — 36%

• Smarter antibiotic use — 0%

• Fixing anatomical problems — 0%

• New diagnostics/technologies — 0%

It’s heartening — and telling — that nearly two-thirds of respondents believe preventive strategies hold the key to transforming UTI management.
This aligns closely with the latest EAU UTI Guidelines, which now prioritise conservative and non-antibiotic interventions as first-line measures for both acute and recurrent cystitis.

“An ounce of prevention is worth a pound of cure.”
— Benjamin Franklin

“Imaging is not about finding everything — it’s about finding what matters.”

The EAU 2025 Prostate Cancer Guidelines reaffirm that all patients with high-risk localised or locally advanced disease should undergo metastatic staging before treatment planning.

Recommendation:

• CT (abdomen/pelvis) and bone scan remain the standard staging tools.

• PSMA PET/CT is preferred (if available) as it offers superior sensitivity and specificity for nodal and distant metastases compared to conventional imaging.

• However, evidence that PSMA-guided staging improves survival outcomes is still limited, so conventional imaging remains the guideline backbone.

• EAU now references the miTNM (molecular imaging TNM) framework, signalling a gradual shift towards molecular staging.

In essence — if you can access PSMA PET, use it; if not, you’re still evidence-compliant.

For patients with BCR after local therapy (surgery or radiotherapy), the EAU now recommends risk-stratified imaging:

Low-risk BCR Gleason <8 and PSA doubling time >12 months

High-risk BCR Gleason ≥8 or PSA doubling time ≤12 months

Recommendation:

• Post Radical Prostatectomy: Perform PSMA PET/CT if the PSA level is > 0.2 ng/mL and if the results will influence subsequent treatment decisions (Weak)
  

• Post Radical Radiotherapy: Perform PSMA PET/CT (if available) or fluciclovine PET/CT or choline PET/CT in patients fit for curative salvage treatment. (Strong)

However, it also cautions that early imaging must be paired with actionable intent — “don’t image what you won’t treat.”

Design (UK-led, multicentre, within-patient, non-inferiority):

Men with suspected prostate cancer had

• bpMRI (T2W + DWI; no contrast) reported first

• then radiologists were unblinded to mpMRI (adds DCE) and re-reported.

• Subsequent biopsy if indicated

• bpMRI omits gadolinium, shortens scan time (~15–20 min), is cheaper, and can expand capacity

• Triage & throughput: bpMRI can be your first-line diagnostic MRI pathway where quality control is robust—freeing scanners and reducing waits.

• Patient experience: No cannula, faster scans, fewer contraindication headaches.

• Stewardship: Lower cost + similar csPCa yield

Overwork in medicine is often disguised as dedication. We glorify the doctor who stays late, takes extra calls, and “just manages somehow.”
But behind that badge of honour lies a slow collapse — not sudden, just invisible.

A few mindset shifts help reclaim the balance:

1. Define your finish line daily.
   Don’t let the day blur into endless tasks. Decide what “done for today” means — even if everything isn’t perfect.

2. Separate urgency from importance.
   Much of what keeps us late isn’t truly urgent; it’s poorly delegated or poorly bounded. Learn to say: “This can wait.”

3. Guard your recovery like a shift.
   Rest isn’t what happens after work — it’s a task of its own. Protect it the way you’d protect an operating list.

4. Reject guilt.
   Leaving on time doesn’t make you less committed; it keeps you capable of caring tomorrow.

Medicine doesn’t need martyrs. It needs doctors who last.

So, step away before you run dry. The patients of tomorrow deserve a doctor who’s not surviving — but present.

Next Webinar – 17th October 2025
Topic: Metastatic Prostate Cancer
Time: 9:30 PM (Pakistan Standard Time) / 5:00 PM (UK)

This session will cover:

• Case-based discussions on metastatic prostate cancer

• Practical updates from the EAU 2025 prostate guidelines

🔗 Register here

Urology, like all of modern medicine, is racing ahead — PSMA scans, bpMRI, AI reports, molecular staging.

We are building astonishing tools to see disease more clearly.
But the paradox is this: as our vision sharpens, our margins blur — time, emotion, attention.

This issue reminded us that the healer’s health matters too. That every minute saved by technology must translate into one more minute reclaimed for rest, family, or thought and ultimately patient care.

Because precision without presence is hollow.

The future of urology isn’t just smarter imaging — it’s saner doctors.

See clearly. Rest deliberately. Heal completely.

— Mudassir Hussain, FCPS, FRCS (Urol), Editor