August 18, 2012
it's never about hypertension
At the top of each chart there is always a Chief Complaint (or CC). It's what the patient is here about today. Or, at least what they told the nurse when they came in. The problem is it's NEVER about the chief complaint. Sure, a patient may have diagnosed hypertension. Their CC may state "follow up for hypertension". And they may in fact not have very well controlled hypertension (chances are they don't). But that's rarely why the patient came in. Inevitably, there is something else going on in their life which prompted the visit. Some new ache. Some old pain. Some new symptom. Some newly observed finding on their elbow. Some completely fabricated symptom. The uncontrolled hypertension is what is most likely going to cut their life short but whatever is hurting in their elbow is what is weighing most heavily on their mind. Hypertension, high cholesterol, or diabetes for the most part, are mostly symptom free. So why worry about something that you can't feel? So you make a deal, albeit not explicit, with the patient. You will address their concern but in return, they agree to actually take their lisinopril, or increase their dose of insulin. It requires some bargaining, some threatening of tough love, and sometimes pleading. It's the art of medicine.