Urological

This episode is an announcement that this podcast is set to close at the end of this month, August 2023. Thank you so much for listening to these episodes of Urological and to my previous episodes from the Why Urology podcast here on this feed.  You still have time to go back to relisten to or save the episodes you really enjoyed or found particularly helpful.  Thank you so much for listening. Be well and do good.

Thank you for listening to this episode of Urological.   

This podcast is an open ended conversation of ideas and topics that center around the practice of medicine and the field of urology.  Recently, one of my younger partners asked me the following question, “Todd, do you have a spot?” IHere is a quote from Stephen King.  “It starts with this: put your desk in the corner, and every time you sit down there to write, remind yourself why it isn't in the middle of the room. Life isn't a support system for art. It's the other way around.” I love my spot at a small desk in the corner of my screen porch. I cherish the time I get to spend here. As an introvert this quiet time fills me. Having a spot is critical to our lives if we are professionals, We need places to be quiet, to think, and to work to solve the world’s problems and even some of our own. Life does not exist to support our art. Its the other way around.  As physicians our “art” is medicine.  Life does not exist to support our practice of medicine. It's the other way around. Our practice of medicine exists to support our lives.        

In this podcast we explore topics and ideas center around the practice of urology and the field of medicine. I am a urologist based in Woodbury and St Paul MN.   Patients ask me all of the time if anything is “new” since their last visit as they try to figure out what options they have as they consider treatment for whatever condition ails them. This is a challenging question because something is always “new.” There is always innovation, ideas, and new iterations. Change is constant. The reason this is top of mind for me is because within the last couple of weeks my partners and I have been exploring and discussing opportunities to innovate within our practice, as well as seeing some significant changes outside of our practice in our local medical community that have the potential to significantly change the way we practice. And I have lost a lot of sleep because of the expected changes. I am concerned that some of the ideas I have heard are a bit too much, impractical if not damaging to our practice if not executed or navigated properly.  There are only two responses to innovation, ideas, and iterations. The first response is to be skeptical, to find the fault in the ideas and to figure out all of the holes in the idea and to determine all of the ways in which the idea doesn’t work. The second opposite response is to look at a half baked idea and to say, “Maybe there is something here” and then to build it despite its imperfections I wonder which of the two I am, a skeptic or a dreamer. The reason I have been thinking about this is that I have spent a fair amount of time this past couple of weeks shaking my head, skeptical of ideas, concerned about radical change, I see and essentially asking over and over again, “Why? why, why, why?” I am afraid that as an older physician, one who views myself as starting the last phase of my career, I am too resistant to change, and afraid of the new, the bold, and the crazy. But I think I should still be dreaming, to see the things that never were and ask, “why not?”  

In this episode, we will be  talking about kidney stone prevention and a very common problem for kidney stone formers, idiopathic hypercalciuria, or having too much calcium in the urine but otherwise normal body calcium metabolism.  This condition is often referred to as renal-leak hypercalciuria.  Calcium is one of the most important minerals in the body. The average adult body contains in total approximately 1 kg of calcium, 99% of which is stored in our bones and teeth.  In our bloodstream calcium also has many regulatory functions. Calcium enables our blood to clot, our muscles to contract, and our hearts to beat. Because calcium is a mineral that is so necessary for life our bodies regulate its metabolism very closely. The system monitoring calcium balance in the body is elaborate and our bodies sense when there is too little or too much calcium in the blood and will work hard to restore balance. Our bodies cannot produce its own calcium. We get our calcium from our food. When we don’t get the calcium our bodies need in our diets, calcium is taken from our bones if our bodies need to maintain calcium balance. A lack of calcium in the diet, or disorders of calcium metabolism, can lead to osteopenia and osteoporosis. What is adequate calcium? Around 800mg-1200mg of calcium is adequate for most healthy, active men and women. Calcium supplementation is used for patients with bone loss or at risk for osteopenia or osteoporosis.   Because calcium is so important in our bodies our kidneys hold on to as much calcium.  That’s a good thing that our kidneys work to resorb the filtered calcium because elevated levels of calcium in the urine can lead to kidney stones.  Calcium readily binds to other minerals in the urine, combining with oxalate and phosphate to produce the common calcium oxalate or calcium phosphate stones. Calcium oxalate stones form the most common form of kidney stones. 80-85% percent of kidney stones are calcium-based. People with normal kidney function lose very little calcium in the urine, less than 150 mg a day, as measured by 24 urine collection. But in kidney stone formers a common finding on 24-hour urine collections is hypercalciuria, higher than normal calcium excretion. A person’s risk of forming kidney stones increases as the calcium levels in the urine rise.  There are a number of reasons there may be too much calcium in the urine but the most common one is idiopathic hypercalciuria. Idiopathic Hypercalciuria is not a disease per se, it is a condition and a risk factor for other diseases, kidney stones being one of them, but also long term, osteopenia and osteoporosis.  No red line determines when a patient has or needs treatment for Idiopathic Hypercalciuria. We know that values above 200mg of calcium excretion for 24 hour is a risk factor for kidney stones but historically we have used cutoffs slightly higher for patients to determine when to start or use medication, as high as 250 mg/day for women and 300 mg/day in men. Often simple dietary changes can be enough to lower kidney stone recurrence risk in patients with only a slightly increased level of calcium in the urine. Increasing fluid intake, moderating salt, animal protein and oxalate consumption, focusing on adding fresh fruits and vegetables and adding Lemonade (often in the form of Crystal Light to decrease sugar load), orange juice or even Lemon juice to increase citrate in the urine may be all a patient needs to help prevent stone formation.  If dietary changes are not effective, however, or if the calcium excretion is very high, then medication is advised. Medication to treat idiopathic hypercalciuria to prevent kidney stones is an ongoing medication, one that is needed indefinitely. The most common medication used for idiopathic hypercalciuria is a class of medications called thiazide diuretics, but another diuretic call indapamide can also be used.   Chlorthalidone is the most commonly used thiazide diuretic because of its long half life but hydrochlorothiazide is effective as well. Thiazide diuretics decrease the calcium levels in the urine. Dose adjustment, increasing or decreasing the dose, is done according to results on 24-hr urine testing. Repeat 24 hour urine test are needed initially to see if the medication is effective but also on an ongoing basis because some kidneys become tolerant to the medication. A short vacation from the diuretic often resets the body and resets the medication’s effects. Thiazide diuretics can have side effects. Thiazide diuretics can be potassium wasting and cause low potassium levels in the blood. A plant based diet or increasing fruits and vegetables in the diet (I joke that I’m a fan a the banana) can increase the potassium in your diet but some patients taking the medication will need to take potassium supplements, either in the form of potassium pills or in some kidney stone formers,  Potassium Citrate. Potassium Citrate has the advantage of not only preventing hypokalemia (low potassium levels) but also increasing urinary citrate excretion.  So there you have it. Some of us have too much calcium in our urine leading to an increased risk of kidney stones as well as other conditions. For some kidney stone formers a simple diet change will be enough to offset the risk of a slightly increased amount of calcium, but for other people with very high levels of calcium in the urine medication may be needed. 

A picture, they say, paints 1000 words. Throughout my practice I have tried to draw as many pictures as I can for my patients. I find that the time I spend in the office often drawing complex anatomical relationships for patients pays off for me in the form of needing to talk less and pays off for the patient in an increased understanding. I find a simple picture drawn for a patient along with an explanation is the easiest way to convey complex surgical techniques and anatomy to help patients understand what we do during specific procedures. The problem is that I don’t draw nearly enough. It takes time and, as I explain to my patients before I start drawing anything, I failed eighth grade art class. My drawings and diagrams would never win any awards, and outside of the context of a clinic visit, probably shouldn’t be shown. But, I have shown my work to others. There is a YouTube video I have on my YouTube channel of my drawing a hydrocele, a collection of fluid around the testicle. It's an example of the types of drawing I do for patients. You can find that here: https://youtu.be/06euCzs7uAQ Our job as physician communicators is that same job that any scientist has in communication. Be brief, be clear, be simple. Don’t talk too much. Carve every word so you say exactly what you mean.  Lastly, stealing from the great physicist Albert Einstein, make it as simple as possible, but no simpler. I understand how my patients must feel when I provide them with a simple drawing, even though I am not a trained artist. The picture remains even though nobody remembers exactly what I said.  In medicine we deal with seemingly complex things, difficult to understand, stuff that fills textbook after textbook with big, and unfamiliar words. We treat patients with sophisticated lab tests, fancy equipment, and a knowledge that takes years to get.  But we must remember that doctor means “teacher” and our job as doctors is to teach, instruct, and educate. To do this we must be brief and clear and as simple as possible.  And a picture often paints a thousand words. I should draw more of them. And so should you. Even if we failed eighth grade art we should hope that our patients leave our office saying, "how can something this beautiful not be right?"   

Kind, Quiet, and Competent. That’s a good starting point for success.  Kindness, Quietness and Competence. Are these foundation elements for success at work? As I reflect on my own performance now over many years of practice I think my failures, times when I have not performed well, may all fall into one of three buckets, 1. A failure to be KIND 2. A failure to be QUIET, and 3. A failure to be COMPETENT. Let me explain...

This podcast is my personal exploration into podcasting and the field of urology, but in some episodes I am blessed with a guest and in this episode we have a great one.  Tom Bergman is a physician's assistant (PA-C) who works closely with the the urologists within my practice. He has gained special expertise working in kidney stone prevention strategies.  In this episode Tom and I review 1 what are kidney stones and why do they form, 2. What are some basic dietary recommendations to prevent kidney stones, 3. What are 24 hour urine tests and what abnormalities in the urine do we find and, finally, 4. We briefly review the most common abnormalities on the 24 hour urines and how we treat them. I think you are going to learn a ton listening to this episode with Tom Bergman. Thank you, Tom, for sitting down for this conversation.  Basic Dietary Strategies for Kidney Stone Prevention Hydrate Limit Sodium Get enough Calcium in your diet Limit or Moderate Animal Protein Limit High Oxalate Foods Eat Fruits and Veggies Link to Jill Harris webpage on high oxlalalte foods.  https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/

The best business strategy, plans, tactics and goals don’t matter if your people aren’t allowed to create or feel something beautiful or purposeful at work, to have a mission, and maybe make a little art that gives meaning to their job.  Here is the automaker Henry Ford on the subject: “Business must be run at a profit, else it will die. But when anyone tries to run a business solely for profit, then also the business must die, for it no longer has a reason for existence.” Hippocrates, often called the father of medicine brought high ethical and clinical standards to medicine in the years he practiced around 400 B.C, but  even Hippocrates, had to have business meetings with his partners, deal with human resources issues, figure out what his competitor practices and other schools of thought were doing at the time to stay current, hire new people and staff, and have enough money left over after a day’s work to buy food and clothes for himself. Sure Hippocrates had a higher calling, but I would have loved to have a video recording of his practice’s annual strategic planning meetings.  Governance, commerce, and mission. Politics, business, and art. Those are the three pillars on which our independent medical practices are built. We have to get our politics right and govern ourselves well, then we have to get our business right but we can’t forget that we have a purpose, a higher mission that gives meaning to our life, our work lives, and to society as whole. We have to remember to put art back into medicine, even if we can’t define it we will know it when we feel it. 

These episodes are my personal exploration into podcasting and the practice of medicine using my chosen specialty of urology as the pivot point.  Most of the episodes that I write and record begin with a single idea, thought, topic, or quote. This episode is no exception, and begins with a book I read recently about James J Hill, one of the most successful railroad magnates of the gilded age in the late 19th century. I recently read a book called James J. Hill: Empire Builder of the Northwest by Michael P. Malone and I read it as part of a book club assignment that, along with Wikipedia and other online resources, is the inspiration nad source material for this episode.  James J Hill was an extremely wealthy man at the time of his death. At the end of his life, Hill was asked by a newspaper reporter to reveal the secret of his success.  Hill responded : "Work, hard work, intelligent work, and then more work.” James J Hill worked. And worked. And worked. He once is to have said, “Give me Swedes, snuff and whiskey, and I'll build a railroad through hell.” Work, hard work, intelligent work, and more work. Such was the life of James J Hill. What fascinates me, what I would love to pick James J Hill’s brain about, is this idea of intelligent work.  What did he mean when he said that? What for James J Hill would constitute intelligent work.  What I am thinking about today in this short episode is the addition of more intelligent work along with work, hard and more work as the key to success as I move forward in my career.  What is that? What does it look like? How do I get it? 

Bladder Cancers begin on the inner surface of the bladder, in the lining cells called the transitional cells. Bladder cancer is most often a transitional cell carcinoma.  Bladder cancers most often grow as a polyp on the surface of the bladder or as a flat tumor called a “sessile” tumor. Bladder cancers can invade the deeper layers of the bladder and they becomes much more likely to spread if they become invasive. Bladder cancers can also grow along the surface of the bladder into something called carcinoma in situ. Bladder cancers can be low grade (slower growing) or high grade (faster growing and more aggressive).  Cigarette smoking is the number one risk factor for forming bladder cancer and blood in the urine is the most common sign or symptom. Tumors that form along the surface of the bladder can be lopped off under anesthesia using a transurethral (through the urethra) resection technique. For many patients this is the only treatment they will need. Patients with invasive tumors or carcinoma in situ need more aggressive treatment.  Bladder cancer is a disease with a high recurrence rate. Even small low grade tumors resected completely have a high risk of recurrent tumors in a relatively short period of time either in the area of resection or in any part of the urinary system where we find transitional cells, most often the bladder but also the renal pelvis draining the kidney, the ureters that transport urine down to the bladder and the urethra. Even the slow growing bladder cancer grow quickly enough that if not caught early enough they will cause complications such as bleeding and pain, or, worse, they can convert to high grade tumors that become invasive. Bladder cancers take constant surveillance to make sure the cancer has not come back.

This is the last in this five part series about content creation. in this episode we will talk about keeping a scheduling. We need to be consistent.  Consistency creates loyalty from the audience, but it has intrinsic benefit to the creator as well. When we think about creation we need to think in terms of a defined length of time, usually daily, weekly, monthly, quarterly, biannually, yearly. And we can even extend those numbers  What should we do every Day, week, month, quarter, biannually or twice a year, yearly, bienially (every two years), quinquenially (every five years) decennially (every ten years) and quadracentenially (every 25 years)? When we create content for the medical practice I believe we should have a long view.  The practice of a physician and a medical practice doesn’t allow for the time necessary for regular tweets and facebook and instagram posts of any meaningful content in my opinion.  Our daily responsibilities take up most of our time. Seeing and operating on patients. checking lab and X-ray results, calling concerned families and taking calls from the Emergency Rooms. Content creation is something important, but it’s not urgent, and often gets pushed to the side and not done. Your schedule will be determined by the type of content you are creating. Some content will take more time. A piece of written content will take you far less time than audio or video content. But audio and video content is all the rage, so choose your efforts wisely and plan acordingly.

We are in the midst of a five part series talking about content creation for physicians and medical practices as a way to do content marketing for the practice.   This episode is dedicated to my fourth principle for content creation: do one thing well.   In the previous few episodes we have explored 1. share information and solve problems, 2. telling a story, 3. reimagine one form of content into a different form. This fourth principle, do one thing well and the next principle, keep a schedule, are the get down to business, get to work principles that require a bit of discipline. As a bit of review, content marketing is putting stuff online that provides immediate value to a potential patient even if they never pick up the phone to seek your services.  Content marketing shows expertise in a field. Content marketing builds trust. Content marketing helps people.  Doctors and professionals of all sorts put themselves online in the practice website, video platforms such as youtube or Vimeo, social media services, advertisements, and even encourage our patient to post reviews on online review sites. We are trying to tell the world who we are, what we do, and why people should choose us for their medical care. All physicians should consider themselves content creators. As physician content creators we want to share info or solve a problems using our expertise in our chosen field of medicine. We need to think of ourselves as storytellers when we create content to make us not boring. And because we serve many different people with many different needs we think to re-imagine our content for different audiences, a blog post for one or a youtube video for another. In the previous three episodes I have tried to expand the way that a physician sees him or herself as a content creator. You can do it; You should do it. Your phone in your pocket has everything you need to get started. But you can’t be every thing to every body everywhere all of the time. The secret to any content creation, or any creative endeavor is that it is hard work and it takes a lot of time and effort to be any good.  Which really brings me to my fourth idea, to put a stake in the ground and try to do one thing well. For most of you and I think for most practices a simple organizational change, and my suggestion, will be to regularly review and update a practice website, the starting place for your content creation. There is always a bit of proverbial bed-making that needs to be done for the practice website. A phone number needs to be changed, a doctor moves out of state and leaves the practice, the current mask policy for the practice during covid needs updating. But maybe in addition to the regular updating of pictures and phone numbers your practice wants to have a place where you regularly update some information or help to solve problems for patients or people just looking to get some help, for lack of a better term we can call it a practice BLOG, and a few well written paragraphs with each post may be all that is needed to tell the story that can help a few patients.  The choice will be yours to make for your medical practice. The key is to get the one thing done well, or as well as you can, even if it seems like a small thing.  Your content creation may never expand beyond that; it may not need to.  But the one thing done well can serve as the foundation for anything else you want to do.  The call to action for this episode if you are thinking about content creation is to choose this year what is the one thing you are going to focus on to do well and to do the work to get it done.  In the next episode I am going to talk about the fifth principle for content creation, keeping a schedule.    

We are in the midst of a series of episodes that I am doing about content creation for the medical professional/doctors/medical practice. This five part series is based on five foundational principles or ideas for content marketing for the medical practice. Content marketing serves three purposes 1. it shows off your expertise, 2. it builds trust, 3. it helps people.  Our #1 job as physicians is to share information or solve problems for our patients. That is the first principle on my list. The trick in our content creation, and one I am far from mastering, is to avoid being boring, tedious, or dull. Which led me to my concept #2: tell a story. We are all storytellers and we all have stories to tell.  Stories educate,  entertain, inform or inspire. Stories aren’t boring. They draw you in and pull you along. Stories are how we understand the world and how we understand ourselves. We tell our stories in many different ways. This brings me to my number three principle: reimagining our content, rethinking one form of educational or informational material into a different form. When we make content for patient education or information we should immediately turn and ask ourselves what else can this be. I have a handout for say kidney stone prevention. Can I make this an infographic or a short educational video for YouTube or TikTok? The answer I think is yes, of course. And I think we should always be considering HOW to do this.  Our printed educational handouts become videos becomes infographics become movies and maybe even an audio or podcast format. The reason we do this is both to expand our reach and the life of our content but also because the different forms will appeal to different people or patient populations. My call to action or encouragement to you is to think in various forms for content creation. For many or most practice our “content” will be simply our website. Other practices will venture beyond to audio and visual content.  But no matter what we do we have to think about what info we want to share, what problems can we solve, and what stories can we tell.  We have many tools for online content creation. All we have to do is use our imagination to be creative and resourceful and to figure it out. Principle #3: Re-imagine your content. 

I have 5 principles or concepts that I think are important for me to remember as I create “content.”  Those five things are  1 share information or solve a problem 2. tell a story 3. reimagine content 4. do one thing well 5. keep a schedule We are working through these 5 principles each as an individual podcast episode.  In the last episode I said the physician should focus on sharing information and solving problems. This is what we do in our everyday lives. We meet with patients one on one in the clinic or hospital setting and, well, share information and try to solve problems. Whenever we create a website, a podcast, a blog post, video, infographic or whatever we are doing the same thing, and we do it one on one because each view of our content is usually one person looking at that content. Your online content is just an extension of what you do every day as a physician. In this episode we try to tackle my #2, principle, tell a story. We are all story-tellers. And we are the stories we tell. Stories are how you and I, how we all, engage with and understand the world and engage with and understand ourselves and each other. The story we are ultimately telling in our content creation is the humble story of ourselves. Who are we? What do we do? How do we do it? Why? What is our mission, our vision, and our values when it comes to how we practice medicine and treat our patients? What do we offer in terms of services, and sometimes more importantly, what can’t we offer our patients? Your content creation tells your story. Your content creation tells us something about you. Tell us your stories.

This is number two in a series of six podcast episodes I am making about content creation for content marketing for the medical practice or medical practitioner. share info or solve a problem tell a story re-imagine content do one thing well keep a schedule For each of the next five episodes I am going to work down the list and break down each principle or concept as I understand it.  These concepts are not original thoughts of mine, just a short list of five things I thought could help me frame what, why, and how to create online content for “content marketing. Marketing is finding our market, our niche, those people who need our services, and letting them know who we are, what we do, and where to find us. The idea in online content marketing is to put stuff—websites, blogs, videos, podcasts, etc.— out into the digital world that helps your market learn about your expertise and creates a bond and a trust that leads someone to become your patient or customer.  We should see content marketing as a positive. It allows those people who need us to find us. And it helps those who don’t need us or who we can’t service to look elsewhere.   If we are a doctor or a medical practice wanting to dive in to online content creation all we have to do to get started is to ask ourselves, what information do I have that I can share, and what problems can I help solve with whatever content I create? If you are a urologist or a urology practice the answer is actually pretty easy. We are experts in kidney stones, enlarged prostates, bladder/prostate/kidney cancers, recurrent urinary tract infections, incontinence and voiding dysfunction and the list goes on. Pick one of those and start typing or hit record on some electronic device and then pick a platform where you are going to put that out into the world.        

First, a huge thank you to those of you who have contacted me to encourage me as I reboot and rebrand the Why Urology Podcast into Urological. Thank you so much for listening and for your ongoing support. 1. share information or solve a problem, 2. tell a story, 3 re-imagine content, 4. do one thing well, 5. keep a schedule.  These 5 things are the 5 principle ideas or concepts that I wrote for myself as a guide when creating content, whether it’s for education, information, marketing, or general engagement with my patients for my practice. Don’t be boring. People get bored quickly. We all have limited time and attention spans shorter than a Goldfish, and we move on quickly when something is dull.  How to not be boring: 1. You do you, 2. be passionately curious, 3. pursue excellence, 4. share with others. Thank you for listening.

Welcome Back to the Why Urology podcast. I am Dr Todd Brandt.  This is a podcast is my personal experiment and adventure into podcasting and is centered around the field of urology and my very, very small place in it. I started podcasting on a lark in the Fall of 2016 with a simple premise. I was going to tell you why urology is such a great field of medicine and why I chose this as a specialty. I was able to write, record, edit and publish 120 episodes of the why urology podcast before deciding to take a break at the end of 2021 and I closed the show with no real plans to start podcasting again. I have spent little time this past year reflecting or asking myself if I was done as a podcaster, or as a content creator, but as I now look toward next year I begin to question if, and what, I may want to put out into the world. This podcast episode is the obvious answer. Apparently, I have more to say. The ancient Chinese philosopher, Lao Tzu is credited with the following quote, “Muddy water, let stand, will clear.” Here is what has become clear to me as I let the muddy water settle on podcasting during this past year away. I have missed the process of writing, recording, editing, and putting episodes out into the world and I would like to start recording them again. OK, but what comes next? First, I want to let you know that I am going to start recording under a different name. The Why Urology podcast will now become, simply… Urological. If you have been a listener in the past you know that many of the Why Urology episodes were only loosely based on something urologic. Much of the time the only association was that I was a urologist. I feel a name change reflects that I expect this podcast will continue to steer away at times from the middle lane of the urologic highway and on to some tangential side roads. Those roads may be bumpy at times, but I think the scenery may be better. Secondly, I want to apologize ahead of time that I am a bit rusty in podcasting and in all things related in any sort of content creation. It may take some time after I have turned on the microphone and opened the tap to let the old rusty water run out until the clear water begins to flow. This podcast will continue to be a work in progress. I both apologize and make no apologies for that all at the same time. I just feel the need to get going. There is a proverb I learned a long time ago that encourages a bias toward action. A word of caution: It was probably something I read from a fortune cookie or was written on the bathroom stall somewhere so take that for what it’s worth. It’s free advice and you get what you pay for. The proverb is this: The work will show you how to do it. The work will show you how to do it. I always took that to mean that if you just get started on the task at hand it will tell you what it needs. The clarity of what, where, how, and when comes in the doing, not from the idea, or the intention to do or the thinking about the thing. It comes from the action. Our task is to do a podcast. My idea is to just start, and to write, record, edit, publish and repeat, to keep going, until the rust is gone and the water runs clear. I appreciate your joining me on this journey, in listening to this episode and continuing to listen under its new name, “Urological” Urological. A podcast by a urologist, and whatever may be on his mind.  

  I will be ending this podcast in its current format at the end of this calendar year, 2021.  I have not run out of ideas for episodes of this podcast. I have not depleted my energy for doing something creative. I still want and would welcome any-and-all guests for interviews and conversations that center around some aspect of urology and the practice of medicine. I still want your comments and feedback. And I am still so grateful that you are listening to these episodes. My idea to start a podcast began around 6-7 years ago when I, myself, discovered the power of podcasting and podcasts in general were gaining a wider audience. For many years medical practices had been trying to figure out how to use all of the tools of “social media” as a form of marketing but also as a way to engage patients.  Video content was always the focus and still is today. Video is easily the most powerful and versatile tool for marketing and education, but video is expensive and difficult to do well. The audio only format of a podcast is far simpler.  It’s cheaper, easier to edit, and nearly as powerful if used within the right context. So here was the thought. Why not try an audio format only rather than spend so many resources on video content?t. The great physicist Albert Einstein said, “I have no special talents, I am only passionately curious.” That is how I started podcasting, no special talents just a passionate curiosity. I have spent many hours of time and energy, and a little money, writing, recording, editing, and posting these episodes. Making this podcast happen has fed my passionate curiosity over the last five years. And although I am no Einstein, my mind has grown during this process and I hope you have learned a little something as well. The truth is that I find it difficult to pack it all up, put it all away and leave this podcast. I feel that I have more to give. I would like to continue to create in some way, to continue to tell stories. As I said in the previous episode of this podcast, we are all storytellers. And if we are a storytellers we first need to know and understand the story we are telling. Does our story inform, inspire, educate, or entertain?  And how is our story told best? On a page, a stage, or a screen? I have tried to tell a small part of the urology story in this podcast. It has been a silly affection, but it’s been really, really fun and I am sad to leave it. Until the next story-time connect with me at whyurologypodcast.com. Be well.              

  Here is something that is true. You and I are all story tellers. My thesis is that a story does one of four things: inform or inspire, educate or entertain. A story teller is one who informs, inspires, educates, or entertains. I was listening to a podcast the other day where a screenwriter was talking about adapting a short story into a screenplay, how some stories lend themselves to the adaption, how the scope of the story changes with the format, and why some great novels, plays or short stories become really bad movies. As a story teller she would say, you have to know if your story should be told on a stage, a page, or a screen. Let’s say you have a story to tell and you have a blank page. The question is does this story want to become a Broadway play, the great American Novel , or a Hollywood blockbuster? Or is it a short format story told best in a literary magazine, a community theater, or an independent short film festival? The story you have determines what you write. As physician story tellers we are asked to inform or inspire, educate or entertain. For most of us in medicine the stories that we tell will be intended for education and information rather than for entertainment or inspiration. As physician storytellers we need to know if our stories are meant for the stage, the page, or the screen.  A famous person once said that the most important part of every painting is the frame. A page lends itself to dense material, detailed pictures, and a reference for going back to later. A stage lends itself to a personal connection, a real time shared experience and developing a relationship between the story teller and the person hearing the story. A screen lends itself to a cinematic experience and story-telling on a large scale. But what, you may be asking, about the podcast format? Hmm. What about the podcast format? If you have been a listener you know that I do not have an answer to that question.  I have tried to tell you a story. I have tried to inform, inspire, educate, or entertain you. I have tried to make it as simple, to speak slowly and softly, to record often and always. I have tried to be complete, concise, clear, concrete, and correct. Finally I have tried to be compassionate. That’s my story, and I’m stickin to it.