GP: “I can tell when my BP is high”

The last patient I saw the other day was, according to my preceptor, a “heart sink” patient. The kind of patient you see on your list that makes you sigh and hang your head in frustration.

This man had uncontrolled hypertension (high blood pressure – BP) simply because he is extremely non-compliant with his medication. He’s visited the clinic numerous times in the past but doesn’t agree on the importance of his medication, despite detailed explanations each time.

He came in with his wife, who said he still hasn’t been taking his medication and when we asked him why, he said, “Because I only take it when I feel my blood pressure is high.”

We asked, “Do you feel that your blood pressure is high at the moment?”

He responded, “No, because when my blood pressure is high, I can feel it in my ears.”

So we measured his BP, it was 190/80 – which was high, and we told him that. And for the umpteenth time, he was told about the importance of maintaining good BP and that he was at risk of having another stroke – apparently he’s had 3 already, one which took 3 years to recover. He’s also on Warfarin (blood thinning agent) so if he were to have a hemorrhagic stroke (burst blood vessel in the brain), it would be a big one that could potentially kill him or cause major complications.

He laughed and said, “I’ve already had 3, I will just have a big one then!”

His wife chirped in, “If you don’t control your BP, you might die tomorrow! You can’t leave me, I need you!” He replied with another laugh.

Needless to say, the consult ended up a waste of time because the patient refused to take the doctor’s advice. On the way out he apologized with a smile and said, “I’m sorry for my… indifference regarding my treatment.”

Perhaps one of the most difficult aspects of GP for me – knowing that your patients know their behaviours (smoking, not taking medications, etc) are putting them at risk of serious illness but despite your continued efforts, they simply don’t want to change.

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