JCPTGP: from the other side of the fence.
Authors: J Bahrami
Journal: BMJ (1986)

Two years after a microbiological study of the uretbral  25 of 31 women had had further symptoms, but only two had sought medical help for their symptoms in the year after the study. Analysis of patients' records showed that women with the urethral  had higher consultation and sterilisation rates and more psychosomatic symptoms and relationship problems than matched control patients. Using the Nottingham health profile women with the urethral  were more likely to mention that health problems affected their sex lives and were more likely to see themselves as having health problems than control patients. Women who have the urethral  are a considerable drain on the doctor's time, and management needs to be directed towards the anxious patient who makes such demands. Seeing the condition as the irritable urethral syndrome may help both doctor and patient to recognise the psychosomatic aspect of the problem. Introduction While studying the urethral  along traditional microbio? logical lines we noticed that it was a short self limiting illness; and that general practitioners were able to predict, before a midstream urine specimen was analysed, which patients had conventional urinary tract infection and which had the urethral  as evidenced by their antibiotic prescribing. Doctors seemed to be able to distinguish between the two conditions from the severity of dysuria and on the psychological make up of the patient. Patients with the urethral  were more likely to present with frequency only than women with urinary tract infection and also presented more psychological illness to their general practitioners than the women with urinary tract infection or control patients matched for age and sex. Furthermore, patients who suffered from the urethral  had made regular visits to the doctor before the study with urinary symptoms, but in a median observation period of 12 months after the study none had consulted with the urethral syndrome. We were sufficiently puzzled by these observations to investigate whether something had happened as a result of the research encounter(s) which altered the subsequent pattern of consulting the doctor for urinary problems in women with the urethral syndrome. The investigation was designed to measure: (a) if these patients had any further urinary symptoms; (ft) if they had symptoms that they were now able to manage on their own; (c) if they had had symptoms but had been reassured by the time spent and the thoroughness of the investigation; and ( investigations frightened them away. We also wondered if the fall off in consultations for urinary S^^iZZ BRITIS IAL JORNAL OLm 292 4 jANUARY 1986 31 Symptoms was more generalised or if patients had focused on another part or parts of their bodies and thus began to present with other psychosomatic symptoms. study sample !n=39) using in depth interviewing to explore the women's perceptions of their symptoms, the possible causes, the problems it created in their lives, and their reactions to the research investigations. For the main practice population ;n-40j were sent a letter explaining the purpose of the studv and requesting permission to visit. Both groups were interviewed at home iRPi using a semistructured schedule. The interview was lape i 97% > of the women with the urethral  had presented with lower mltclH^During tha^amu^ir 'su ?23%  ?O?ll, had more relationship problems (p--0 011, and wiih Ihc ureihral  focused on another area of their bodies.