Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, December 10, 2002
    Tonight I called a patient of mine about her mother, who is also my patient. I'd seen Mother (age 85) last week for a blood pressure check. Her BP was sky high as usual. I asked her if she'd been taking her medication and she admitted she hadn't been. I asked her why not: "Well, doctor, I have to confess I've been a naughty girl. I just stopped taking it."

    Internal monologue: "I asked you WHY NOT, you wizened elf, ANSWER ME!"

    Out loud: "Well, when did you stop taking it?"

    Mother: "Oh, it couldn't have been that long ago. There's still four in the bottle."

    I look at the bottle. I last saw her September 20. I gave her 30 pills. That means she's only taken 24. She's been out of it for a month and a half. To doublecheck, I call the pharmacist (the number's on the bottle) and he confirms no refills.

    IM: "You stupid widget."

    OL: Firm lecture. "I'm calling your daughter. I want her to make sure you take your pills from now on."

    Mother: "Oh, doctor, that really won't be necessary."

    OL and IM: "Oh, yes it will. Now I want you to get back on these pills and I'll recheck your pressure in a month."

    Not mentioned above is the fact that Mother is deaf as a post, so I have to repeat all of my remarks at least three times in a very loud voice.

    So tonight I finally reach Daughter and tell her this story. She reacts with shock. She tells me she's asked her mother every morning if she was taking her pill and her mother told her yes. I believe her - I think Mother just doesn't want to take the stuff.

    Daughter: "Do you think there may be some problem with confusion? Her memory?"

    I tell her that whether there is or not, we have to get her mother's blood pressure under control before we do anything else. Interesting medical fact: a large percentage of dementia cases are not Alzheimer's but seem to be related to uncontrolled BP - multi-infarct dementia from multiple strokes is one such scenario, but hypertension alone over time seems to have damaging effects on the brain. One study took Alzheimer's patients with high blood pressure, treated their blood pressure and their confusion got better. So did their memory.

    So always take your blood pressure medicine, boys and girls!

    I have to admit, though: as I hung up the phone some part of me felt like I'd won, like when you get the last word in some petty argument. What kind of bitter, burned-out bitch of an internist would exult in scoring over some old lady?

    I WOULD.



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