Abstract：
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 Mol\'s 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 the sociology of diagnosis has already noted that diagnostic steps are often re-ordered by health-care professionals taking diverse actions in the best interest of their patients. This article contributes an argument that ordering diagnostic work around antimicrobial stewardship agendas has the effect of narrowing possible actions. Exploring the consequences and effects of doing diagnosis in this way for different groups, I argue that a greater creativity about what could be done to care for painful bladders could be found in a return to more clinical ways of working.
摘要：
尿路感染（UTI）的诊断是医疗工作的常规部分，但公认是临床不确定性高的领域。同时,由于对抗生素过度处方的担忧，UTI的诊断对全球政策制定者变得越来越重要。借鉴Mol在临床工作中的本体论多重性概念，我探讨了如何通过英国国家UTI诊断算法将诊断不确定性协调为确定性。UTI的诊断是作为事先决定是否开抗生素的事后合理化而产生或保留的。诊断社会学方面的工作已经注意到，医疗保健专业人员通常会根据患者的最大利益采取各种行动来重新排序诊断步骤。本文提出了一个论点，即围绕抗菌药物管理议程订购诊断工作具有缩小可能行动范围的作用。探索以这种方式对不同群体进行诊断的后果和效果，我认为，在回归更多临床工作方式时，可以找到关于如何治疗膀胱疼痛的更大创造力。
