8 MARCH 2024

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Test flaws are being overlooked , say urologists .

Sarah Simpkins UTI guidance is outdated and needs an overhaul to acknowledge chronic UTIs and the limits of culture assessments , urologists say .

Adelaide urological surgeon Dr Ashani Couchman says diagnosis criteria based on white blood cell counts and a bacteria count of 105 colony-forming units / mL are “ fixed and archaic ”.

She says the definitions for a positive culture had been established in the 1950s based on “ a study of about 70 people who had a kidney infection at the time ”.

“ That has not changed since , which is extraordinary ,” says Dr Couchman , a Urological Society of Australia and New Zealand ( USANZ ) board member .

‘ You are going to kill off some that you never knew existed .’

The society is reworking its position on Australian UTI clinical guidelines , which differ between states .

“ If you follow all those guidelines , not everyone who presents with what seems like a UTI has , by the definition , a UTI ,” Dr Couchman says .

“ So the diagnosis can sometimes be wrong , and treatment can sometimes be wrong or not long enough .”

She said standards for testing , including dipstick tests and culture assessments of MSU , were “ flawed ”.

Agar plates for culture assessments used a growth medium that favoured certain bacteria , she said .

She said it showed infection could involve multiple bacteria , but doctors could be missing a range of them .

“ It is like providing the right fertiliser … If you do not provide a broad-based fertiliser , you are going to kill off some seedlings that you never knew existed .

“ You have skewed what you are growing , so you are skewing your findings ; you are diluting your findings .

“ We need an acknowledgement

or clear comment that says : ‘ This is what we are doing , but these are the limitations .’”

She added that traces of epithelial or skin cells in urine samples were deemed contamination under current guidelines .

“ But there is more

PAGE 5

Dr Ashani Couchman .

Paul Smith THE RACGP is calling on the Medical Board of Australia to review the impact of its CPD changes on the specialty amid claims from doctors the reforms are failing .

In an interview with Australian Doctor last month , board chair Dr Anne Tonkin defended the revamp , which includes new mandatory requirements to review performance , assess outcomes and write professional development plans .

“ We have put in place something that the board believes will improve practice and will improve outcomes for patients ,” she said .

But she said it was too soon to review the impact of the changes .

Dr Tonkin was responding to the Australian Doctor survey that found widespread discontent .

When asked whether going through the CPD program last year helped them in maintaining their practice standards , the vast majority said no ( see the results , page 3 ).

RACGP president Dr Nicole Higgins said the board ’ s CPD requirements “ should be informed by data and reflect what we know works ”.

“ We would welcome an assessment of how the changes have affected both GPs ’ quality care

82 %

8 % and their wellbeing , as there was significant concern from GPs ahead of the changes introduced ,” she added .

“[ Working ] as a GP necessarily includes learning and developing new skills that we integrate into practice .

“ It ’ s really vital that this is recognised by the [ board ] and that GPs practising in the community are recognised for this with as little extra work as possible .”

‘ Requirements should be informed by data .’

She referred to the college ’ s original 2020 submission to the medical board on the draft CPD standards .

It warned that its members were concerned the system would “ place more pressure on GPs , escalate already poor levels of morale [ and ] increase stress ”.

Based on the results of the college ’ s own member survey , it added : “ As GPs practise across a wide and diverse range of environments , there was significant concern that the proposed changes would introduce inequity and disadvantage [ for ] those PAGE 3

Should the board scrap the current CPD requirements for registration ?

10 %

Yes No Don ’ t know n = 869