Clinical Review Evidence based case report

Asymptomatic haematuria … in the doctor

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7228.165 (Published 15 January 2000) Cite this as: BMJ 2000;320:165
  1. Chris Del Mar (c.delmar@mailbox.uq.edu.au), professor
  1. Centre for General Practice, University of Queensland, The University General Practice, Inala, Queensland 4077, Australia
  • Accepted 19 April 1999

The patient was waiting in the consulting room; everything was nearly ready. The occasion was the examination in general practice for fifth year medical students. We run an objective structured clinical examination. For this part, the student had to measure the patient's blood pressure (the “patient” was actually someone recruited from our general practice), test his urine using a dipstick, and report to the examiner within the five minutes between bells. Just one thing was missing—the midstream sample of normal urine for testing. Because I did not want to disturb the volunteer patient, I collected it from myself. I measured the patient's blood pressure again (this had to be done after every 10th student)—it was stable. And I tested the urine to check it was normal—it was not.

For the next two hours, students either told me (or, in the case of those less skilled at this technique, did not tell me) that there was a trace of blood in the urine. This was not a problem as far as the examination was concerned because the marking was not affected by the test result. But it was a problem for me. What should I do? I tested my urine again a week later, and when I found it was still positive I sent a specimen to the laboratory. The report stated that urine culture was negative but confirmed the presence of normal red cells (30/ml).

Conventional medical teaching had taught me that bleeding must come from somewhere. The model that sprang to mind first is summarised in the table. I then checked with a textbook of surgery.1 I had forgotten tuberculosis and schistosomiasis as causes of haematuria. A textbook of medicine2 suggested further …

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