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Psychology in #Urology

Unconscious bias is a systematic cognitive error in decision-making, about which the decision-maker is unaware.


Unconscious bias against #bladders is common, especially infected ones. Compared to other organs, progress in #cystitis management has barely changed for ~ ¾ of a century, despite incidences increasing, recurrences abounding, and AMR becoming more pervasive, because of antiquated, flawed and haphazard treatments. We challenge “haphazard” through #antibioticstewardship but blithely accept “antiquated and flawed.” Other common non-surgical bladder problems fare similarly badly (e.g, urgency, inflammation, pain).           


Cystitis is one of the most common human #infections and the most common hospital acquired one. #Urinarycatheters (don’t mention “the bladder”) are heavily implicated. Cystitis gums up hospital services, causing both direct, and widespread complications, so you might expect it would receive a lot of attention. No such luck.


Healthcare is failing far too many people through disdain of bladders. It seems men’s much lower incidences of cystitis, primeval aversions to intrusion into beloved penises or “incontinence disgust” may be the reasons.


The long-overdue, recently accepted diagnostic category, “chronic UTI,” doesn’t even indicate they overwhelmingly are bladder infections.


We’ve made almost no progress in reducing the burden of cystitis other than with implementing hygiene for CAUTI prophylaxis, a 19th century idea, and through expeditious catheter removal, just common sense.


Urologic surgeons are deemed the experts in bladder healthcare, but surgery actually has no role to play in most cystitis management. Urologist attendees at Bladder Health UK’s latest conference were sparse. Nurses dominated.


Last summer’s British Society of Antimicrobial Chemotherapy’s June conference opened with, “we know almost nothing about managing UTI.” That statement really applies only to cystitis.


Unconscious bias against bladders actually belies its profound effects on healthcare from primary, through intensive care. Will raising awareness campaigns, like NHS England’s last October, make a difference? If so, thanks for reading.

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