Dipstick brigade is taking the pee with elderly patients

Copperfield argues that, in elderly patients, the urine dipstick has become a substitute for thinking – with predictably frustrating consequences

Sometimes, to save the NHS, you have to look at the smaller picture. A tiny stupid thing repeated thousands of times adds up to a massive stupid thing, aka a shedload of hassle, dysfunction and expense.

Ladies and gentlemen, I give you the urine dipstick. Or rather, I take it away, stamp on it, and urinate on it (and not for diagnostic purposes).

A brain-shredding day duty is always good for an epiphany. According to the care home staff, a mildly doolally LOL was acting slightly doolallier yesterday, so they dipped her wee, obviously. It was leucs +ve and nit-ve. She’s fine now, but ‘just in case’, they dipped it again today. It’s still leucs +ve; so can they have some antibiotics?

No. But they can have a lecture on the sheer uselessness of urinalysis in elderly patients. They’re positive half the time, whether there’s a UTI or not. So they might as well toss a coin, and even if they used a gold sovereign each time, that would still cost less than what they spend on urine dips.

I’m not often one to quote guidance, but it suits me here. So, here we go UKHSA 2020 ‘Diagnosis of UTIs’, re: adults over 65: ‘Do not perform a urine dipstick’. Any questions?

Especially deserving of a special place in hell are the proponents of ‘routine’ urinalysis in the elderly (risible) and catheter specimen urinalysis (always positive – what do you expect if you’ve got a hosepipe up your urethra?).

Arch GP pragmatists on a busy day might still be tempted to dip in the confused elderly as a means of vindicating the antibiotic they were going to give anyway. Well OK, be arch and pragmatic by all means, but what will you do if the dip is negative?

However, the worst offender is, of course, A&E. The inevitably positive (aka trace of protein) dip in the unwell elderly gives them permission to stop thinking, because the solution is nitrofurantoin and advice to see the GP if no better. It is surely only be a matter of time before I read: ‘88 year old lady, confused, axe in back of skull, dip +ve, diagnosis: UTI’.

Repeat, ad nauseam, every day, in care homes, surgeries, A&Es, pre-op assessment centres and patients’ homes up and down the land. The result is a pandemic of unnecessary antibiotics, actual diagnoses delayed , more antibiotics when the first don’t ‘work’ , drug reactions, C diff et al and drug resistance Armageddon.

So the real reason they’re called ‘dipsticks’ is because of the people using them.

Dr Tony Copperfield is a GP in Essex