“There is nothing so deceptive as an obvious fact.” Sherlock Holmes

What did Sherlock mean when he said that? He meant that it is human nature to want to arrive at answers quickly and easily, and then stop looking for the correct answer. When a crime has been committed, the easiest and most tempting thing to do is accuse the person who looks like a criminal, or who has a previous criminal record. As Sherlock says, the fact that this appears to be the obvious solution to the crime is what prevents people from seeking additional clues and arriving at the correct solution. As he says to his companion Dr. John Watson, “You see the same things as me Watson, but you fail to notice the details and apply deductive reasoning to them. Once you have eliminated the impossible, whatever remains, however improbable, is the solution.”

The same thing happens in medicine – family members — and unfortunately many doctors — settle on the most obvious and available diagnosis, but then fail to look for the clues to the correct diagnosis. This is why so many elderly patients are incorrectly diagnosed with Urinary Tract Infections (UTIs). Judging from the number of UTIs that are diagnosed in the elderly, one would think that there is an epidemic of UTIs! What is going on?

Several things are contributing to the rampant over-diagnosis of UTIs.

First, it is popular. Obviously it’s not the condition itself that is popular. What I mean is that it is a popular topic on social media and in conversations. Its very popularity is what drives it to the top of google searches when people attempt to self-diagnose because Google arranges its results according to popularity, not correctness.

The second problem is that when the elderly are evaluated in the emergency department, they are often diagnosed with UTI. Why? Because it is a quick and easy diagnosis that nobody questions, and can be easily treated and discharged home. But don’t they test the urine? Yes they do, but they don’t interpret the results correctly.

The third problem is confusion about the results of a urinalysis. People think that the presence of bacteria in a urine same means UTI. The fact is that 90% of urine samples take from everyone on the street will have bacteria in them. But 99% of them will not represent urinary tract infections. What? Why? Because the sample has to be collected correctly and interpreted correctly which is often not the case. Furthermore, many people walk around with bacteria living happily in their bladders without causing harm. This is called “colonization” and it is not an infection.

Finally, the last problem is exactly what Sherlock was referring to: there are many other explanations for a patient’s symptoms. Settling upon UTI and failing to look for the other possible causes of symptoms results in incorrect treatment and possible harm to the patient. And no, giving antibiotics “just in case it’s a UTI” is not okay. Incorrect use of antibiotics is what leads to bacterial resistance in patients, and can lead to life threatening infections for which we have no treatment.

So, here is what you should you take away from this: The practice of medicine is complicated, diagnosis takes mental discipline and a vast fund of medical knowledge. That’s why doctors go to school for so long and are strictly regulated and licensed by the government. Furthermore, Google is not a diagnostic tool, and if you are not a doctor you should not be diagnosing disease or telling the doctor what you have diagnosed. When your mom or dad get sick, you should tell the doctor what the symptoms are, and let the doctor do what she is trained to do. When a diagnosis is given, you should ask them to explain it so that you understand it. If they diagnose a UTI, you should ask them if the urine sample was a “clean catch”, and whether a Urine Culture and Sensitivity was done on it to grow out any bacteria that was found, to identify the bacteria, and to determine what antibiotic is appropriate. You should also ask them if they eliminated any other possible causes of the symptoms. If the answer to any of these questions is “no” then you should ask them why.

The bottom line is your parents deserve proper medical evaluation and diagnosis by a doctor, NP, or PA. If you are not a doctor, you should not diagnose them.

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