Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What this patient needs for a normal blood pressure

Hans Duvefelt, MD
Physician
March 22, 2015
Share
Tweet
Share

Dwight Frost had all the risk factors, plus he had already had a stroke several years ago. His blood sugars were too high, his lipid profile was near the top of the class, he still smoked a cigar now and then, and his blood pressure hovered around 200. He also seemed a little vague about which medications he actually took and which ones he didn’t.

He spoke rapidly with a slight tremulousness in his voice and seemed to be eager for the visit to be over.

On his second visit, he brought a big bag of medications, not just the neatly written list his wife had sent him in with the first time. Some of the bottles were marked on the lid “a.m.” or “p.m.,” others said “BP,” “sugar” and some had a rubber band around them, which seemed to mean he was definitely taking them as prescribed.

His thyroid function and other routine labs were normal. At both visits I recorded his blood pressure in both arms; I had him sit and stand; the first time I saw him, I also checked the pressure in his right leg.

His wife was a retired nurse, he told me, and she also checked her own blood pressure with a stethoscope and a manual sphygmomanometer. She had recorded almost daily blood pressures, all under 140, which she had done on him between his two visits with me. She couldn’t come in with him, because she was actually bedridden from severe arthritis. She rarely got out of the house to see her rheumatologist, the only doctor she had.

I thought for a moment. There was only one way I could resolve this, so I asked:

“Would you mind if I stopped in next Friday afternoon to check your blood pressure when you’re relaxing at home?”

“Anytime, were always home,“ he answered.

Friday afternoon I drove across town in a light snowfall. The faint February sun filtered its way between the snowflakes, which seemed to sparkle and rotate in the air ahead of me without ever hitting the windshield.

The Frost home was a tidy ranch house with an ell connecting it to the garage. Dwight saw me drive up and greeted me at the door.

Ada, his wife, was lying on a daybed near a pellet stove in the paneled room. A large Persian cat was sleeping at her feet.

Dwight walked over to a Canadian rocker near his wife’s bed and sat down. As we made small talk, the majestic cat woke up and moved over to Dwight’s lap. Slowly, almost absentmindedly, Dwight patted the cat and told me she was almost twenty years old.

I noticed that Dwight spoke without the tremor in his voice I had heard at the office, and he exuded a calm that I had not seen in him before.

ADVERTISEMENT

As I watched from the chair he had offered me, a slow ritual unfolded before me. With the cat in his lap, Dwight placed the blood pressure cuff on his arm and gave the stethoscope to his wife. “Ready,” he said to Ada, and when she nodded, he pumped the cuff up and then slowly deflated it.

“134/82,” she said.

I walked over, put my own cuff on his arm instead and pulled out my own stethoscope from the pocket of my tweed jacket.

As I pumped up the cuff, Dwight patted his cat, who started purring, and leaned his head back against the back of his chair.

Slowly deflating the cuff from a high of 240, I listened in anticipation. At exactly 132, I heard the first Korotkoff sound. I continued to deflate the cuff and finally had my answer.

“Your blood pressure is fine,” I said and reached down to record the numbers. “It’s just high when you come into the office. So, why don’t you come and see me in three months, and just bring your readings from home.”

I gathered my equipment. As I looked up again, Ada and Dwight were holding hands. He was not the same anxious man I had seen in the office twice before. The cat was still in his lap, sleeping.

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

Prev

Our health system is changing, and it's a damn shame

March 22, 2015 Kevin 46
…
Next

The physician distribution problem shouldn't be a surprise

March 22, 2015 Kevin 15
…

Tagged as: Cardiology, Primary Care

Post navigation

< Previous Post
Our health system is changing, and it's a damn shame
Next Post >
The physician distribution problem shouldn't be a surprise

ADVERTISEMENT

More by Hans Duvefelt, MD

  • The art of asking where it hurts

    Hans Duvefelt, MD
  • Thinking like a plumber when adjusting medications

    Hans Duvefelt, MD
  • The American food conspiracy

    Hans Duvefelt, MD

More in Physician

  • How market forces fracture millennial physicians’ careers

    Shannon Meron, MD
  • Unity in primary care: Why I believe physicians and NPs/PAs must work together toward the same goal

    Jerina Gani, MD, MPH
  • Guilty until proven innocent? My experience with a state medical board.

    Jeffrey Hatef, Jr., MD
  • How to balance clinical duties with building a startup

    Arlen Meyers, MD, MBA
  • When life makes you depend on Depends

    Francisco M. Torres, MD
  • Implementing value-based telehealth pain management and substance misuse therapy service

    Olumuyiwa Bamgbade, MD
  • Most Popular

  • Past Week

    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Apprenticeship reshapes medical training for confident clinicians

      Claude E. Lett III, PA-C | Conditions
    • How American medicine profits from despair

      Jenny Shields, PhD | Policy
    • How market forces fracture millennial physicians’ careers

      Shannon Meron, MD | Physician
    • What I learned about health care by watching who gets left behind

      Maanyata Mantri | Policy
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Apprenticeship reshapes medical training for confident clinicians

      Claude E. Lett III, PA-C | Conditions
    • How American medicine profits from despair

      Jenny Shields, PhD | Policy
    • How market forces fracture millennial physicians’ careers

      Shannon Meron, MD | Physician
    • What I learned about health care by watching who gets left behind

      Maanyata Mantri | Policy
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What this patient needs for a normal blood pressure
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...