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At the heart of general practice since 1960

A dipstick's guide to urinalysis

Dr Tony Copperfield

Sometimes, I feel it my duty to ignore the bigger GP issues of the moment and instead reflect on other, nittier and grittier bugbears.

And so it is today that my emergency doctor stint has focused my mind on one irritation which has, for the past 12 hours or so, seriously ruined my life. I’m referring, here, to the unsolicited abnormal urinalysis result.

I reckon I’ve had about seven of these today (only slightly above average). In each case, the sample was taken by a nurse, the result involved some combo of protein/blood/nitrites/leucocytes, and the request was, you guessed it, to prescribe antibiotics. Each arrived in some form which made clarification difficult (task, telephone message, fax etc). And not one of these requests contained any clinical context whatsoever because, hey, when did that ever matter when you’ve got a dipstick lit up like a Christmas tree?

I’m writing this partly to cathart, and I do feel better already. But, also, on the off chance that the odd community nurse might be reading this, in which case, please note:

1. Just about all elderly people have abnormal stuff in their urine, on account of having bladders that are as old as they are. These findings are often irrelevant.

2. So have a really good reason for checking the urine in these patients, and if you don’t, don’t.

3. It is impossible to respond sensibly to these results without knowing why the specimen was taken in the first place. If you don’t understand this, and the kind of frustration it causes, I’ll illustrate by making an urgent request that you go forth into the community to apply a dressing to a patient, but I won’t say where, why, or to whom.

4. Don’t even begin to think about dipping the urine of catheterised patients because, unsurprisingly, having a hosepipe up your urethra inevitably causes ‘abnormal’ urinalysis findings. Try it yourself if you don’t believe me.

5. You are seriously spoiling my day, and adding to the antibiotic resistance problem.

6 If you ignore 1-5 above then I am going to empty the contents of the next specimen bottle over your head.

Dipsticks? Exactly.

Dr Tony Copperfield is a jobbing GP in Essex 

 

 

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Readers' comments (8)

  • Bornjovial

    We had the same problem and after discussion with our nurse have developed a form for patients to fill in if come to see the Nurse for urinary symptoms or if they drop a urine sample off at reception!!!
    Trying to direct simple uncomplicated cystitis to our Nurse prescriber ended up with patients dropping in a sample whenever their wee is smelly/strong/discoloured/they feel out of sorts or in some elderly (whenever a family member goes to see them- just in case).
    This form asks all the relevant questions without being onerous. We haven't audited the antibiotics issue for UTI before and after this plan do so after 3 months to see if it makes a difference.

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  • On a related note, it appears members of the public often "latch on" to diagnoses and suspect them in a much higher incidence than they actually occur. UTI in children is one and it seems even when a child is clearly ill from the copious snot escaping their upper airways they have been conditioned to bring me a urine sample "in case it's a UTI". When I drop it in the clinical waste in front of them they soon stop doing it...

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  • I have had this for years at each OOH shift. The catheter has been dipped and the dementia patient is just not quite right. They usually hold a gun to your head by saying that the family will not be happy unless ABs are issued as "she goes off quick". I have gone as far as an article in the nursing home newsletter but still no change.
    Now I have given up. Anyone for ceflex?

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  • How about the fax from the midwifes about the urine they dipped in clinic two weeks ago, and the Hb of 11 which apparently requires me to prescribe iron tablets urgently on FP10

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  • spoilsport,I have only got four specs from this mornings duty doctor session and was disappointed ,hoping to set a record.seven sounds pretty good to me.any higher offers?

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  • Had a nursing home call me urgently about a patient they thought had a UTI because the dipstick showed there was "specific gravity in the urine" 😂😂😂

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  • This is indeed a common problem. The context is important. When I worked down in East Kent at the regional centre where I had to take urological referrals from the whole region, this proved to be a stumbling block without the whole clinical picture.

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  • Amelia Joseph

    Join the To Dip Or Not To Dip tribe...QIP to stop the use of dipsticks in care homes altogether - reduced antibiotic use and no increase in admissions - everyone's a winner!
    If you're interested check out the training animation at https://youtu.be/rZ5T1Cz7DHQ

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