Ted Ritchie, MD

AVOID THIS DOCTOR IF YOU ARE LOOKING FOR A DOCTOR THAT IS MAINLY CONCERNED ABOUT YOUR WELL BEING! Consultation and Prescription I saw Dr. Ted Ritchie at Urology Clinics of North Texas for evaluation of nocturia. During the consultation, we reviewed the two available classes of overactive bladder medication, an older class that works by blocking bladder muscle receptors, and a newer class that works through a different receptor pathway to relax the bladder. Dr. Ritchie agreed that the newer-class medication carried the least, if any, urinary retention risk of the available options, and that given my other daily prescribed medications for urinary flow and erectile function, it was the appropriate choice to avoid compounding retention risk. He prescribed the lower of the two available doses on that basis. The Reversal My insurer required documented failure of an older first-line medication before approving the one he prescribed. I asked his office to submit a step-therapy exception… request citing the same clinical reasoning discussed during my visit. His office declined. When I followed up directly, Dr. Ritchie stated that the medication he prescribed carries the same urinary retention risk as the older class of alternatives, and that he could not "ethically" tell my insurer otherwise without me first trying and failing another medication. This is a direct reversal of the clinical position he stated to me in person, for the same diagnosis, within the same course of care. What the Published Evidence Actually Shows A multi-study analysis of approximately 22,000 patients across randomized controlled trials found the newer-class medication had a significantly lower rate of urinary retention compared to seven older-class comparators. A separate analysis of 14 studies and 10,774 patients found fewer total adverse events with the newer-class medication compared to the older class overall, including lower rates of gastrointestinal disorders and dry mouth, with comparable efficacy and treatment adherence between the two classes. A review of 20 studies found the newer-class medication reduced postvoid residual urine, the direct clinical marker used to assess retention risk, a finding not consistently replicated with the older class, which works by reducing bladder muscle contraction directly. I was prescribed the lower of the two available dose strengths, which is generally associated with an even more favorable tolerability profile than the higher dose used in most of the trials above. Why the Mechanism Matters for This Specific Case The older medication class and my other prescribed urinary flow medication work through different but overlapping pathways in bladder and prostate muscle function. The older class reduces bladder muscle contraction directly. Combined with a medication that also relaxes urinary tract muscle for flow purposes, this raises a legitimate compounded retention concern, one Dr. Ritchie himself raised during the consultation, before reversing it. The Core Issue I am not disputing a physician's right to decline a treatment approach he believes is unsupported. I am documenting that the specific clinical justification he gave for reversing his own recommendation, that all options carry equal retention risk, is not supported by the peer-reviewed literature comparing these two medication classes, and directly contradicts what he told me in the exam room. A patient should be able to rely on a stated clinical rationale from their physician remaining consistent when that same rationale is needed for insurance documentation. That did not happen here.