Bibliographic record
Abstract
ashing down a couple of ballpark franks means a trip to the gents after the home half of the sixth inning.Bladder bursting, I find myself at the wall of urinals with 31 fellow Jays fans (and one burly Minnesotan with a well-worn Kirby Puckett jersey).Easy enough, 700cc's on deck, but then the familiar feeling.There's not a chance on this earth I'm peeing here.A shuffle of the feet, eyes dead ahead, a centering breath, some imagined pelvic floor relaxation.Nothing.A flush nearby means go time, valsalva time!All this produces is a tiny, sour bleat and inguinal canals straining like Dizzy Gillespie's cheeks.The Ballad of the Shy Bladder is sung again as the crowd attenuates and the dam finally bursts.This is a glib paruresis anecdote, but it is the thin edge of the wedge of a glaring care gap in the urology clinic.The impact of cognition, mood, anxiety, and mental health in the etiology and treatment of our patients' problems is enormous, and the median urologist is, at best, marginally trained to stickhandle these issues.Anxiety and adjustment disorders are woven into oncology; we are trained to break bad news and to empathize with time, tone, and tissues.Social workers stand ready in cancer centers.Multidisciplinary pain clinics have long brought psychologists into the public system; sure, we recognize the impact of coping and catastrophizing, but we rely on expert colleagues to help tackle that part.In these cases, the issue may become that the expected psychological reactions to cancer and pain reach escape velocity and wreak havoc.Where we are lacking is most conspicuous when disordered thinking may be etiologic, as so often in patients with voiding or sexual dysfunction.A social life addled by the prospect of incontinence.Elaborate rituals and mantras to find the peace to empty one's bladder.An urge and ache to void that never abates.A 40-year-old athlete in knots about erections that simply stopped working.Urine normal.Anatomy normal.Cystoscopy normal.It's here we see our patients ensnared in cognitive short-circuits, an answer to the diagnostic puzzle resolving.We've written about it and even named it."Uropsychiatry" first showed up in 1964, and dozens of low-fidelity expositions on "neuroses" and "psychosomatics" followed, but these buds never bloomed into a therapeutic field. 1 We know of the Hinman "non-neurogenic neurogenic bladder" in kids, 2 but when we reach back into our clinical toolkit, we find only a crude glossary of terms and a list of care providers, who are not us, best suited to help.And so, we deploy the tools we have.Manage your fluids and triggers, a β3 or PDE-5i, hoping to start a positive cascade or exploit a placebo effect, rooting in earnest and feeling impotent ourselves.Sometimes we shrug and dig up a card or number for a colleague psychologist, social worker, or physiotherapist outside of the public system.We silo our specialties in medicine as a means of categorizing disorders and to provide some order in how to train ourselves to manage them.Diseases, though, don't care about our taxonomies as they smatter themselves about our bodies and minds.This leaves urologists as gatekeepers for vexing pain, voiding and sexual issues that have often already eluded our toolkits before we've laid eyes.Patients have taken their concerns to their primary care team, and when referred to us, have every reason to believe we are the experts in their issue; however pridefully we cling (or fall back?) to our status as surgeons of the genital and urinary tract, we are also the medical doctors for the same (remember your personal letter and interviews?;).You may think this is not a problem, or at least not our problem, but that's a shortcut to unburdening ourselves of the care of our patients.If you believe undermanagement of the cognitive and psychological aspects of urologic disease is a real issue, how might we tackle it?
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.015 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.008 | 0.006 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.015 | 0.027 |
| Insufficient payload (model declined to judge) | 0.030 | 0.018 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".