‘When all you have is a hammer, everything has to be a nail’: Diagnostic Uncertainty in Urinary Tract Infection

Diagnosis of urinary tract infections (UTI) is a routine part of medical work and yet is well recognised to be an area of high clinical uncertainty. Meanwhile, diagnosis of UTI is becoming increasingly important to policymakers globally due to concerns about antibiotic over-prescription. Drawing on the concept of ontological multiplicity in clinical work, I explore how diagnostic uncertainty is co-ordinated into certainty by a UK national diagnostic algorithm for UTI. The diagnosis of UTI is produced or withheld as a post-hoc rationalisation of a prior decision whether to prescribe antibiotics or not. Work in sociology of diagnosis has already noted that diagnostic steps are often re-ordered by healthcare professionals (HCPs) taking diverse and innovative actions in the best interest of patients. This article contributes an argument that the insertion of antimicrobial stewardship logics here has the effect of narrowing possible actions. I link this way of doing diagnosis to a broader trend of pessimism in international policy efforts to mobilise on antimicrobial resistance. Exploring the effects for different groups, I argue that a greater optimism and creativity about what could be done to care for painful bladders could be found in a return to more clinical ways of working.