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.
Dr Tony Copperfield is a jobbing GP in Essex