Medical reasoning and patient requests in decision-making for female genitourinary infections

The aim of this study was to investigate General Practitioners' (GPs') collection and analysis of data on women presenting with lower genitourinary (GU) complaints, also taking into account patient preferences. For 135 patients seen after nurse triage, eleven GPs recorded the clinical data they had explored, an evaluation of the patient's desire (or not) for medical interventions, a preliminary diagnosis with certainty estimate, and management actions. Whether a clinical data item was explored varied between 97% of the patients for fever to 15% for pelvic examination. Decisions regarding diagnosis followed to a large extent results from screening laboratory tests. For prescription of antibiotics the patient's desire (or not) for medical interventions was a significant discriminant. The GPs reported the lowest diagnostic certainty for diagnosis of urethritis, the highest for cystitis. Factors contributing to physicians' uncertainty in their decision-making were assumed patient reluctance for medical interventions and negative screening tests. In conclusion, patient requests and preferences significantly influenced the GPs, even though results from screening laboratory tests were mainly used as the basis for decisions. The high reliance on screening tests may often cause other clinical information to be neglected. Thus, the uncertainty regarding patients with negative laboratory test results may reflect that important information is not included in the clinical analysis.