DEAR DR. ROACH: How do I get primary care doctors to understand that I do not do any health screenings and that their badgering only infuriates me more. My feeling is that if you’re not going to treat me, why test me? I only need the doctor for prescriptions and referrals to a specialist if I choose to see one. I am a nurse and do not need their lectures. As a patient, I have the right to autonomy and when I choose to use it. — Anon.

ANSWER: Primary care doctors recommend screening tests because we prefer to find serious conditions earlier rather than later. As a nurse, you might not have seen a person who comes in with obstructing colon cancer and terrible pain, and who will then be treated through a necessary emergency surgery that is still unable to cure the disease.

Primary care doctors see many cases of early prostate and breast cancer, and we know that treating enough of these cases will prevent a few people from dying of these diseases. We believe in the effectiveness of preventive care. It is certainly true that it is your body and your choice, but understanding why we recommend health screenings might make you less infuriated when we do.

I am also concerned about what seems like a dismissive attitude toward the role of your primary care provider, such as a family medicine doctor, internist, or nurse practitioner. We aren’t here to simply send you to a specialist and refill prescriptions. Primary care practitioners save lives not only through health screenings but by conducting a careful history exam and really listening to a patient, who may have noticed symptoms that indicate something serious. We do a physical exam to try to identify diseases in their early states.

I have many patients who are nurses and physicians, and we work together as partners — each with the goal of promoting wellness, treating disease if it is present, and trying to identify early signs of serious problems. I hope you consider this approach and that you will find your meetings more productive.

DEAR DR. ROACH: Please address the issue of UTIs (urinary tract infections) in elderly women. It has happened to three of my friends and myself. We are in our 70s and 80s, and one has a son who is a doctor. In all four instances, it took hospitalization to diagnose the urine infection.

Please tell doctors to understand that this happens quickly and without warning. Why are they so surprised and reluctant to give antibiotics when this happens? In the elderly, UTIs can happen without any symptoms until they or their families realize how confused they are. It’s so unnecessary.

Now I keep testing strip/supplies and don’t wait until I start losing my grip on reality to know there is a problem. Please bring awareness of this problem to the public and to doctors! — M.H.

ANSWER: Urine infections, like lung and other infections, often have vague or nonexistent symptoms in older people until the condition is fairly advanced. Sometimes confusion is the first symptom — a condition known as acute delirium, which is dangerous.

I certainly agree that physicians need to take confusion seriously as a symptom of potentially severe illness and that testing for urine infections is wise. However, there are many other conditions, like pneumonia or meningitis, that can also cause confusion, so I don’t agree with prescribing antibiotics without a careful evaluation.

Older women with recurrent urine infections should be considered for treatment, such as prophylactic antibiotics, but they should also be considered for hormone therapy to prevent bacteria from getting into the bladder in the first place. I also use urine test strips for some of my patients in this situation.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved