Driving While Hypertensive
The Second Law of the Dinosaur states:
It is impossible to make an asymptomatic patient feel better.
So true.
Chapter 2 of my book, Declarations of a Dinosaur, discusses how I handle a patient who may be asymptomatic at present but who will not remain so for long without taking my advice. Essentially, I explain in as much detail as necessary to create just enough anxiety, which can be relieved by doing what I say, be it taking pills, quitting smoking; whatever.
Another way of looking at it is that although the patient may not feel there’s anything wrong with him, my anxiety spikes when I see things like a hemoglobin A1c of 14 %*. All I have to do is find a way to get my patient to feel the same level of alarm as I feel.
This is what I did a few months back when I saw an African American gentleman with a blood pressure of 210/130. He hadn’t been to see me in quite a while (I think his BP had been a little elevated then and he was afraid of what it was going to be now). It also turned out that his LDL was 180, and his A1c was 12%. I felt like I was on the verge of a cardiovascular event just sitting there in the room with him! With that collection of risk factors, he was literally a heart attack waiting to happen. And that’s what I told him.
He felt fine. No chest pain; no headache; no retinal changes. No symptoms at all (which was why he didn’t meet the criteria for a diagnosis of Hypertensive Urgency with its attendant trip to the ER). Still, as I ...
Source: Musings of a Dinosaur - Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
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