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Not sure whether I bullied Dr into prescribing antibiotics (probably belongs in AIBU)(7 Posts)
I am currently 22 weeks pregnant and woke up this morning with UTI symptoms- stinging when weeing, blood in urine and feeling slightly unwell.
Made an apt with the GP and explained symptoms. She asked if the blood could have come from any other exit point- said definitely not. She also ruled out thrush symptoms and then did a urine dipstick. Before heading to the GP I had necked lots of water and squash trying to shift the infection so when the dipstick was performed it was negative for traces of blood. She said she would send the sample off and call me on Friday if I needed an antibiotic but since dipstick was negative she wouldn't treat with antibiotic straight away.
During my afternoon at home, I continued to have blood in each wee and stinging when going. I felt a bit funny about leaving things until Friday since I know that UTI's in pregnancy can have worrying effects. I checked NICE prescribing guidelines (I'm a pharmacist so understand enough not to misinterpret them) and they said that initial management of UTI in pregnancy should include prescribing an antibiotic whether or not the dipstick sample reveals blood in urine.
I called the surgery and asked to speak to the Dr I saw or another if she wasn't available. The Dr I saw phoned back and I explained my concerns. She said I had described my symptoms vaguely (I don't think this is true as I'm used to listening to patients describe symptoms and feel I communicate well generally). She also said the dipstick was negative therefore no blood in urine. I pointed out that I have seen blood in the urine several times and that antibiotics should be started (according to NICE prescribing guidelines) whether or not a positive dipstick result is seen. This went back and forth for a while until I told her that I'm a pharmacist, well aware of the symptoms of a UTI and don't understand why guidelines aren't being followed.
The dr reluctantly issued a prescription which I have just picked up, but probably wrote 'time waster' all over my notes.
Was I unreasonable to challenge the Drs decision and push for antibiotics regardless? Can any other mumsnet Drs explain why she may have decided not to follow NICE guidelines? I hate being pushy and challenging but felt I didn't have an option on this one.
You were not being unreasonable to point out NICE guidelines and ask her to follow them and clearly it worked! Lucky you were clued up enough to look them up as the Dr obviously wasn't aware of them. Prescribr whether or not blood is seen on dipstick if blood in urine is reported by patient seems pretty clear.
I was taken to hospital at 20 wks with a suspected uti and given antibiotics even though nothing showed up in urine tests, ended up off work for 3 weeks after then developing hydrophalisis because of it! You are defiantly right to have pushed for antibiotics, uti's are rotten at the best of times let alone when pregnant!! Hope u start to feel better
Did your urine show any nitrates in urine? These are usually present with bacterial uti. I suppose the Dr could only go off what she was presented with and as no blood (frank or microscopic) or nitrates then made a clinical decision not to prescribe. To be honest though, I probably would have pushed for some antibiotics especially as you had seen blood. I always find in pregnancy that everything is put down to a uti! Your urine hopefully won't grow anything and you will start to feel better soon
She didn't mention nitrates either way. Didn't take my temp, do any kind of examination and didn't seem to be aware of prescribing guidelines that are clear in saying that antibiotics should be prescribed whether or not blood present in sample presented if other symptoms are consistent with UTI. I feel more annoyed about it this evening I think as I still have blood in the urine and the other symptoms are worse if anything and would be panicking at this stage if I didn't have any treatment.
Thank you for replying everyone, I'm reassured that it was fair enough to push for the anti-b's. Might have to get used to this being assertive lark!
I think doctors often need reminding that patients know stuff too. We're not all time wasters who think you treat a cold with antibiotics.
Hope you feel better soon.
Thanks Mountain totally agree. The nhs are all about 'no decision about me without me ' and all that. I'm starting to feel much better today so I'm pleased I was pushy!
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