Thanks, everyone. I’ve been waiting for a bit more information before posting an update.
As noted, I sent my questions to my PCP. While waiting for her response, the clinic called to clarify that what the culture report meant was that the sample was contaminated and thus couldn’t convey any information. The person I spoke with told me to talk with my PCP and also to consider a repeat urine test. The nurse I’d seen sent a message via the portal that included “If you have new or worsening concerns about your health, … please call or return to the clinic or office where you received care. If your symptoms get worse, or if a new problem starts, call the clinic.”
I left a portal message for my PCP: “[Clinic] clarified Saturday that the urine culture was contaminated, so I’d like to repeat that again as well.” She quickly replied to ask, “Do you want to repeat that urine at our follow up appointment [sic; it’s an annual exam, not a follow-up] on 7/10/23?” The back story here is that her team has decided not to order labs prior to a visit, which I guess I understand for routine tests, but not for non-routine events. Note that she didn’t offer me an earlier appointment. I replied, “Good morning. No, I’d like a repeat urine test, plus urine/blood tests for kidney stones, kidney function, and bladder cancer ASAP.”
She made no reply all of yesterday. At 11:30 this morning, I called the clinic, explained that I was following up per instructions, and was given an appointment an hour later for a repeat urine. This I did after the med tech explained to me in dumbed-down language and tone how to do a clean catch. Frankly, I’ve done plenty of these in my life; this was the only one to be contaminated, but fine.
Then the nurse (it’s all the same nurse in this story) came in and was quite brusque with me. She asked why I was there, and I explained. She said I should contact my PCP. Ah, I thought, I’m getting the “You’re trying to exploit the system” response, so I said that I was following up as suggested by the clinic, and that I had contacted my PCP but she was not responsive to my request for the repeat urine. She told me that if I couldn’t get through on the phone, I should use the portal. I politely explained that I had used the portal but my PCP wasn’t engaging about my request and I wanted to be sure the antibiotic had been effective (a concern this nurse had raised as a reason to do a culture on the last visit). She said that if my symptoms had abated, it was a UTI and the medication had been effective. I said that the bleeding had stopped before the first dose, that I’d taken the 10 doses, but I wanted to have the repeat testing that had been suggested. She snapped that acute onset bleeding with quick resolution was consonant with a UTI diagnosis and that I no longer had the UTI. I did not say “absence of evidence isn’t evidence of absence” because that doesn’t build rapport. I did say that I’d consulted with medical friends and wanted to get the test information because of the overlapping signs of UTI, bladder cancer, and kidney issues. I reminded her that my urine was cranberry juice-colored (which she had seen and commented on). She said, “Well, one of those people should order tests.” I said that they were out of state and my friends (not just you all; I have MD friends), and that I’d attempted to have the repeat testing done but my PCP offered only waiting two weeks and that I wasn’t comfortable sitting with a potential infection for that long.
She whipped her computer screen around and said, “There’s no evidence of infection” from the dip they’d just done. Might have been nice to lead with that. She started to turn the screen back to herself and I asked, “Wait, may I look at that a little longer? I need to put my glasses on.” She seemed quite angry and generally was interacting with me in the way that people seeking opioids are treated, but I’ve worked in hospitals, so I just ignored the tone. Today’s salient results, which she hadn’t yet showed me, were:
Bilirubin: Negative
Ketones: Negative
Blood: Negative
Ph: 6.0 (reference range: 5-9)
Protein: Negative
Urobilinogen: 0.2 (this is in range and 10% of what it was the first time I went in)
Nitrite: Negative
Leukocyte esterase: Negative
This is great, and I have no idea why she didn’t lead with this. She then said there was no reason to send it for a culture. I said that I’d like it sent because the dip isn’t always very accurate and I wanted more information to help confirm the diagnosis. She challenged this and I said, because if further assessment for bladder cancer or kidney function is needed, I want to do it soon, and I’d rather not have a cystoscopy if it wasn’t needed. She again pushed back on ordering it, and I said, “Look, I’m trying to do my medical diligence here.” She punched at the keyboard and said, “There, the order is sent.” I thanked her. She replied, “If this one’s contaminated too, we’re not doing another.” Okay. I thanked her again for her help.
She left the room, apparently done. I waited a little, then walked out to the hall and found her. I asked if I could have a printout of the dip results (which the med tech had brought me on the first visit). Without a word, she printed it and handed it to me. I thanked her; she again didn’t say anything.
I found this all quite peculiar, since I was being adherent with treatment, had followed the instructions she’d given, wasn’t trying to score drugs, was polite and not reactive, and as a person with insurance, was paying for all of this. The clinic was empty when I arrived and left; I wasn’t keeping her from other patients. So fine, I won’t go back there on this issue.
It’s now 36 hours since I wrote back to my PCP; there’s still no reply. Ah, well.