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Fri Jun 8, 2018, 12:56 PM

Just had a patient dream up every reason in the world why I don't need to treat his hypertension.



I tried to tell him how bad high blood pressure is for his health.

He didn't care. He told me he's not having any symptoms.

I told him patients rarely do, until right before it's about to kill you.

He didn't care.

I told him treatment is simple and convenient.

He didn't care.

So I gave up.

A patient has to consent to his treatment, and he didn't want it.

If he comes back and tells me he's changed his mind, I'll give him 100% of my ability. But if he declines treatment, there's nothing I can do...

22 replies, 580 views

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Reply Just had a patient dream up every reason in the world why I don't need to treat his hypertension. (Original post)
Aristus Jun 8 OP
unblock Jun 8 #1
greymattermom Jun 8 #2
Aristus Jun 8 #3
IADEMO2004 Jun 8 #4
OriginalGeek Jun 12 #21
In_The_Wind Jun 8 #5
Aristus Jun 8 #6
In_The_Wind Jun 8 #7
CTyankee Jun 12 #14
MFM008 Jun 8 #8
Wounded Bear Jun 8 #9
Xolodno Jun 8 #10
BlueSpot Jun 8 #11
Randomthought Jun 12 #12
Aristus Jun 12 #13
Randomthought Jun 12 #18
RobinA Jun 12 #15
Aristus Jun 12 #17
RobinA Jun 13 #22
SCantiGOP Jun 12 #16
LuckyCharms Jun 12 #19
Aristus Jun 12 #20

Response to Aristus (Original post)

Fri Jun 8, 2018, 01:00 PM

1. you can't cure stupid.

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Response to Aristus (Original post)

Fri Jun 8, 2018, 01:00 PM

2. Maybe get it in writing?

So if anything happens, there will be a record of his declining treatment.

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Response to greymattermom (Reply #2)

Fri Jun 8, 2018, 01:01 PM

3. Yeah, I put it in his chart.

'Patient declined treatment'.

Provider documentation is all that's needed.

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Response to Aristus (Original post)

Fri Jun 8, 2018, 01:03 PM

4. Well don't give up. Took a decade to get me talked into this weeks colonoscopy.

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Response to IADEMO2004 (Reply #4)

Tue Jun 12, 2018, 05:34 PM

21. I recently had my first

and yes, it was many years after they started trying to get me to go. The thing is, I can't figure out what everyone is complaining about. The prep wasn't nearly as bad as everyone makes out and, afterwards, I've been having the best movements I can remember ever having. Without getting into graphic detail, let's just say everything comes out OK in the end.

They found 6 polyps, they got them all, biopsies were negative and I get to go back in 3 years. I might not wait that long.

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Response to Aristus (Original post)

Fri Jun 8, 2018, 01:20 PM

5. Some people just need a bit more time to think about it.

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Response to In_The_Wind (Reply #5)

Fri Jun 8, 2018, 01:22 PM

6. Well, if he comes back, I'll get him the best treatment I can think of.

It's just frustrating to see one indifferent to one's health...

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Response to Aristus (Reply #6)

Fri Jun 8, 2018, 01:25 PM

7. Maybe he voted for the guy in office now ...

and sees the error of his ways.

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Response to Aristus (Reply #6)

Tue Jun 12, 2018, 10:55 AM

14. I have high bp and I greatly appreciate these life saving drugs (Verapamil and Atenolol).

I could understand resisting the idea of a colonoscopy or surgery such as the spinal surgery my husband had to fix his stenosis. But bp meds?

Could it be that he is resisting your treatment because of an irrational fear?

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Response to Aristus (Original post)

Fri Jun 8, 2018, 01:33 PM

8. Dr's couldnt even

Keep my dads BP down with medications.
It blew out his heart and kidneys.
He's been gone 18 years now...
This patient will find out how seriously
He should take this soon enough.

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Response to Aristus (Original post)

Fri Jun 8, 2018, 01:54 PM

9. My older brother had quadruple bypass surgery...

started smoking again within a year. Died a few months later. Cancer, apparently, though I never got the full story.

Things like that almost make me embrace the conservative view of medicine. Almost.

But yeah, not much you can do for someone who won't let you.

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Response to Aristus (Original post)

Fri Jun 8, 2018, 11:27 PM

10. Got diagnosed with AFIB last week...

Damn straight I got the medication to lower my pulse. Saw the Cardiologist a few days ago, everything is back to normal, so he told to continue on the current medication plus add a baby aspirin.

My mom had a stroke in her 40's, her sister in early 50's and their first cousin died of a stroke in his late 50's. I sure is shit ain't taking any chances.

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Response to Aristus (Original post)

Fri Jun 8, 2018, 11:53 PM

11. I remember when I got that diagnosis

I resisted because I felt like it was an indication of weakness or perhaps some sort of personal failure. Yeah, I know that doesn't make any sense, but it was emotional and not logical. Fortunately, that didn't last long. Been on the meds for some 20 years or so now and everything is good.

I think it was learning that it was largely genetic (grandparents, parent and siblings had it too) that made me relent as it clearly wasn't my fault. And yes, I realize how stupid that sounds/was. Makes me blush to post it. Hindsight is definitely 20/20.

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Response to Aristus (Original post)

Tue Jun 12, 2018, 09:50 AM

12. Has he tried any meds for high BP?

I'm on my fourth and still having sided effects. After the first med I swore off treatment and thought again and tried another and and yet another. I'm on my fourth now and sometimes my BP goes too low and I almost pass out.
Considering tha all BP meds are central nervous system depressants and all cause brain fog ( some worse than others) I can understand someone not wanting to continue taking the meds.
I'm actually considering the surgical solution

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Response to Randomthought (Reply #12)

Tue Jun 12, 2018, 09:59 AM

13. Have you been evaluated for resistant hypertension?

Last edited Tue Jun 12, 2018, 01:32 PM - Edit history (1)

Blood pressure that is resistant to a multiple-drug therapy is often caused by obstructive sleep apnea. If that seems to be the case, I order a sleep study for my patients, and follow up appropriately if it's positive for OSA. Also, resistant hypertension can often be improved significantly with a diuretic like spironolactone.

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Response to Aristus (Reply #13)

Tue Jun 12, 2018, 01:12 PM

18. Thanks for the info

All the drugs I have tried have lowered my BP but the side affecrs were not acceptable. The first on I was allergic to; I'm allergic to sulfa antibiotics and also react to sulfonamide in other drugs so that rules out even some diuretics as well as Losartin.
The next one I tried caused such severe edema that I could barely walk. The third was caused me to get dizzy and I passed out in Joann fabrics -lots of drama there and the one I'm taking now is OK but it causes brain fog and I have given up on my senior citizen college classes.
Sometimes it's just not worth it for stage 1 hypertension. At the moment I'm on a weight loss program to get rid of 20 extra pounds and to try and get more exercise. I think that might take care of it
But it's difficult for anyone to make needed lifestyle changes when they can't get their shoes on or think and plan efficiently.
I hope you are sensitive to your patients not wanting to give up activities because of drug side effects.

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Response to Randomthought (Reply #12)

Tue Jun 12, 2018, 12:12 PM

15. My Grandmother

(who died in 1993) had sky high blood pressure most of her adult life. 210. Periodically she'd try a new med and she HATED the way they made her feel, so she just went without. Died at 85 of sepsis. Not using this as an excuse not to treat BP, I take my meds without side effects thank goodness. But it was like her system just wasn't made for lower BP.

In defense of the aforementioned patient or people like him - I just came from a check-up for my fairly routine and low level 60 year old problems, and sometimes you just have to draw a line. Get this screening test (radiation), get that screening test (radiation) with 1 in 4 false positive rate, eat this food (that used to be certain death but is now healthy) that you have to cook specially, try to find this food that they don't sell in regular stores, workout more, workout differently, take this med, lose weight, stop smoking. I do some stuff, take medication, stopped smoking (not good enough, now I need lung cancer screening tests YEARLY AND to lose weight because I gained when I quit), workout when can I... But if I'm going to have life that's worth staying alive for I can't spend every non-working minute maintaining my health. On the up side, if I get the yearly lung cancer screening and the extra MRI's that result from the false positives, the mammograms will catch the resulting breast cancer...

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Response to RobinA (Reply #15)

Tue Jun 12, 2018, 12:34 PM

17. Certainly there is a great deal of over-evaluating and over-treating out there.

The majority of medical providers want to provide appropriate, efficacious medical care, though. If a patient succumbs to something that could have been prevented, the provider is going to be asked a lot of questions as to proper monitoring, evaluation, treatment, follow-up, and so on.

It's not worth risking the loss of our licenses to let a problem, or potential problem, go un-addressed.

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Response to Aristus (Reply #17)

Wed Jun 13, 2018, 08:32 AM

22. I Get What

you are saying. Unfortunately, if my doctor is practicing defensively rather than based on his or her educated judgement I feel I can't trust her to give me good advice and I'm left using MY judgement, which is not educated in this area. Couple years ago I had a discussion with a doctor as to a screening test once every one or two years. I knew he wouldn't give me a straight answer, but I asked anyway what his recommendation was. 1 or 2 years. His response was, "Whatever works with your lifestyle." Completely non-helpful. Cancer screening a lifestyle choice?

I am 60 and most of my old style, judgement-using physicians have retired and I am beginning to have no choice but to deal with the practice-by-protocol breed. I don't feel safe or comfortable with them, because I don't trust them. I do understand their predicament, but that doesn't help my aging self.

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Response to Aristus (Original post)

Tue Jun 12, 2018, 12:21 PM

16. I never hesitated to start my BP meds in my forties

I have the same personality as my Dad and his Mom's side of the family. She dropped dead at 46 in a grocery store back before they had medical treatments. My Dad lived a healthy life and died at 86. He was always skeptical about doctors but admitted that he would never had lived that long had he not treated his blood pressure. Had he not worked at a facility that required a yearly physical he probably would never have been diagnosed.

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Response to Aristus (Original post)

Tue Jun 12, 2018, 04:46 PM

19. I never resist recommended treatment, probably because my doc...

is very deadpan and matter of fact.

As an example..."You have hypertension. If you don't treat it, your kidneys will fail and you will die".

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Response to LuckyCharms (Reply #19)

Tue Jun 12, 2018, 05:19 PM

20. Good for him. And good for you.

I'm never that blunt. But I get the point across.

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