Posted by: notdeaddinosaur | November 18, 2009

Whose Medicine is it Anyway?

Hypertension, or high blood pressure, is one of the most commonly diagnosed chronic conditions seen in this country. What many people don’t realize, though, is that a single blood pressure reading is not enough to make a formal diagnosis of hypertension. Technically, you need three readings on separate occasions — preferably different days — to make the diagnosis. Because I like to use sports analogies, I tell my patients that the diagnosis of hypertension doesn’t happen until you have “three strikes.”

What I usually do when I first measure a blood pressure higher than 140/90 is to explain this to the patient. I also discuss the role of weight loss, exercise, and sodium restriction in reducing it. Then I ask them to come back in a month to re-check the blood pressure. With any luck — and with aggressive lifestyle modifications on the patient’s part — a mildly elevated blood pressure can respond before I ever make the diagnosis, coincidentally sparing the patient the official record of a “pre-existing condition.”

I saw a guy the other day with “strike two”. His blood pressure was still about 150/100. He wasn’t all that overweight and his diet was already pretty good, so I started trying to prepare him for the fact that he would likely require medication to control his blood pressure. Like many people, he wasn’t keen on that idea. He scowled as he said, “Okay, we’ll give it one more month. Then I guess I’ll take your damn medicine.”

I thought, “What do you mean, my medicine?” My blood pressure is fine (as are my cholesterol and thyroid, thanks to better living through chemistry). I’m talking about medicine for you, Mr. Patient. Which got me to thinking:

Whose medicine is it anyway?

As prescribing physicians, we often talk about all the medications at “our” disposal. Is studying, understanding, recommending and writing for drugs enough to invest us with their “ownership”? Or does filling the prescription, paying for and swallowing the pills carry more weight?

I guess that’s the source of the expression, “to take one’s medicine.”

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