Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Tuesday, September 16, 2008

Another Cool Analogy

Saw another patient today with blood pressure just a little too high; same as it was the last time I saw him. I told him to come back in a month; that was four years ago.

This time he's back because he's (rightfully) proud of his recently improved diet and exercise regimen. Much to his dismay, his blood pressure is still just a hair over 140/90 -- and he really doesn't want to take medications.

I asked him what kind of work he does: he's a real estate agent.

Once again, I came up with an analogy specific to his line of work to help him understand why I was recommending we medicate his blood pressure:

I pointed out that he was like someone wanting to sell their house who had already spent a great deal of time and effort preparing the house for marketing; the last thing they'd want to do was something else, especially if it cost more money. I told him to imagine the sellers had already done a wonderful job, but that he as a professional was obliged to point out that a few more little details -- perhaps painting the crown molding to make it *pop* -- could make the difference between getting an offer close to or even above their asking price, or having to settle for less money to avoid having the house languish on the market. I pointed out how his suggestions might sound to the sellers; they could easily take it as criticism that they hadn't done enough.

That was the context of my suggestion for blood pressure pills. He had done such a good job with his lifestyle modifications -- he was at his ideal weight -- that all he needed to optimize his health was a little help, even though it was something he was loath to do (take pills.)

I saw the same "Aha!" reaction from him as I had previously. Unfortunately, he still wanted to wait a few more months before admitting that meds were what he needed. Oh, well; one for two ain't bad.


At Thu Sep 18, 01:54:00 PM, Anonymous Anonymous said...

Tell him how high BP can lead to a stroke leaving him paralyzed or kidney failure with dialysis...

At Thu Sep 18, 04:50:00 PM, Blogger #1 Dinosaur said...

No good; I also see the champion of BP non-compliance: creatinine up to 4.5 (from 3.3 six months ago), LDL of 234, BP of 230/140. No response to all my dire warnings about dialysis and stroking out. I do ask at each visit if the life insurance is paid up.

This patient is small-fry.

At Fri Sep 19, 12:51:00 PM, Anonymous Anonymous said...

My BP goes up to 194/104 when I visit my family doc, but is ''normal'' in all other situations and with other docters. Could this be the case with your guy?


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