Urinalyses

[BoardingDoc]

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Well....the whole reason why we have conversations about asymptomatic HTN and UAs is that people f'ing treat them. Don't treat it, and we will never talk about it!

Literally just dced a patient who was sent in from his PCP (confirmed via review of the chart) which read "BP markedly elevated, patient will require hospital evaluation due to severely increased risk of stroke/MI."
He was there for a cough / asthma exacerbation and just wanted some prednisone. He had also been taking cold meds and hadn't been taking his BP meds... which he told his doc about as well and which they documented. I literally told him "yeah, we don't send people to the hospital for that anymore. Your doctor should know better."
I wrote him for his prednisone and he happily left.

 

[thegenius]

Literally just dced a patient who was sent in from his PCP (confirmed via review of the chart) which read "BP markedly elevated, patient will require hospital evaluation due to severely increased risk of stroke/MI."
He was there for a cough / asthma exacerbation and just wanted some prednisone. He had also been taking cold meds and hadn't been taking his BP meds... which he told his doc about as well and which they documented. I literally told him "yeah, we don't send people to the hospital for that anymore. Your doctor should know better."
I wrote him for his prednisone and he happily left.

Love it. That should happen 100% of the time. And the PCP should be forced to go back to school or retake 2 months of med school. Or fined 100 dollars every time that happens.

 

[TooMuchResearch]

This entire thing is like the asymptomatic hypertension conversation.

Yes, you can spend half of your on-shift life explaining this to patients who come in at 2am because for some strange reason they decided to check their blood pressure as they were waiting for the microwave to heat up a midnight snack...

OR you can just order a BS CBC/CMP/trop/CXR/work-up, have them chill out in the WR, and magically dispo them 2 hours later (depending on if the chem panel machine is working or not) when surprise surprise, their repeat BP is now lower and "great news! your tests came back looking great!" Level 5 chart, happy patient/family, shows you "did something" and no real harm brought to the patient (I know some pedant is going to talk about the nebulous-on-an-individual-patient level iatrogenic harm this may cause, but in this medical climate it's just not a cultural priority).

The inertia behind the patient or patient's family anchoring on "last time it was a UTI!" is far too great. It's effectively in the public discourse now, and you're asking for a tough career trying to educate every single one of these patients/families. Don't get me wrong, there are a lot of them who will take your advice and knowledge with a giant heap of appreciation, but there are also a lot that simply DGAF about your expertise and just expect antibiotics/Rocephin/admission for "altered mental status" "dehydration" and "urinary tract infection."

This Sounds right. They come to our coliseum for the show. Give them the show.

 

[TooMuchResearch]

Well....the whole reason why we have conversations about asymptomatic HTN and UAs is that people f'ing treat them. Don't treat it, and we will never talk about it!

BTW, the single biggest thing that any doctor does is educate their patient. What do you think pediatricians do all the time. I am aware that sometimes it's more pleasurable to stick your finger in your own eyeball, but most of the time you just say I'm not going to treat your asymptomatic HTN and UA and just move on. Rarely are you dragged in for a throwdown of epic proportions with a patient.

Also a good point.

 

[ScepticSkeksis]

Anyone else have a problem where lab does "reflex urine culture" on all positive results? Then the poor day doc has to figure out what to do with the patient who has EBSL Klebsiella but asymptomatic bacteriuria.

 

[RoyBasch]

This Sounds right. They come to our coliseum for the show. Give them the show.

“ARE YOU NOT ENTERTAINED?!”

 

[Brigade4Radiant]

The UA just gives people a reason for fatigue oh he has a UTI oh your urine is positive

Anyone else have a problem where lab does "reflex urine culture" on all positive results? Then the poor day doc has to figure out what to do with the patient who has EBSL Klebsiella but asymptomatic bacteriuria.

We have the PA/NP do that. If the patient is aysmptomatic regardless of what the culture shows we don't do anything.

 

[Rockinacoustic]

Anyone else have a problem where lab does "reflex urine culture" on all positive results? Then the poor day doc has to figure out what to do with the patient who has EBSL Klebsiella but asymptomatic bacteriuria.

The ED pharmacists do follow-up at my site.

As such, there's nothing I loathe more than calling the multiple medical complaints (but no GU symptoms) patient to see how they're doing 3 days after discharge once the triage urine culture finalizes

 

[TooMuchResearch]

“ARE YOU NOT ENTERTAINED?!”

I have partners who argue with patients about influenza tests when the patient almost definitely has the flu. They came in for the test. Just do it and move on. That's the only way to kill the Emperor in the finale.

 

[BoardingDoc]

I have partners who argue with patients about influenza tests when the patient almost definitely has the flu. They came in for the test. Just do it and move on. That's the only way to kill the Emperor in the finale.

I split the difference. I do the swab and then tell the patient (truthfully) that it can sometimes take a few hours to result and that I'm "not going to make them wait for that" and have them check their results online on the patient portal in a few hours. I don't rx tamiflu or paxlovid except in rare cases as is, so it isn't like the swab is changing mgmt.

 

[TooMuchResearch]

I split the difference. I do the swab and then tell the patient (truthfully) that it can sometimes take a few hours to result and that I'm "not going to make them wait for that" and have them check their results online on the patient portal in a few hours. I don't rx tamiflu or paxlovid except in rare cases as is, so it isn't like the swab is changing mgmt.

Yeah, a lot of my patients will just check online for results. Some like to wait for some reason.

 

[Dred Pirate]

The ED pharmacists do follow-up at my site.

As such, there's nothing I loathe more than calling the multiple medical complaints (but no GU symptoms) patient to see how they're doing 3 days after discharge once the triage urine culture finalizes

yup- the least favorite part of my job is calling somebody who already had vague symptoms and then having to hear 10 other things that have gone wrong - I guess I choose the right profession in the fact that this is just a minor part of my job, not having to actually interact with patients all day every day.

PS - question for all - For "mixed flora" NOT "normal urogenital flora" - what do you do if they were not rx'd any meds? From what I know most of the time (but not all) it is contaminant- but not always. IF there are symptoms and a high colony count - we have been treating with keflex or macrobid, but no symptoms, we don't treat, but that means I have to call them and go through the above debacle.