Hyper and Tense

Hypertension is really an insidious disease. Tiny changes in blood pressure (even just 5 mmHg) can have a substantial effect on mortality and morbidity. That surprised me. I'm not even sure my precision with the blood pressure cuff has error bars that small. Furthermore, there are few symptoms related to high blood pressure. Without warning, the patient may be at risk for strokes, heart attacks, cardiomyopathy, retinopathy, and nephropathy. It's scary. Furthermore, it's hard for people to take medication since there are no symptoms of hypertension. You feel worse when you take medication because of the side effects. Thus, fighting hypertension is a tough battle.

In other news, we had a case in Foundations of Patient Care that spanned three weeks. On the first week, we interviewed a standardized patient at the clinical skills center. After taking note of his symptoms and history, we began to form a differential diagnosis. The next week, we followed his case closely, and unfortunately, a perceived pneumonia turned out to be a lot more severe. The last week, we wrapped up the case and also met the standardized patient again to practice a motivational interview to encourage him to stop smoking. All in all, the case was fascinating. I really enjoy exercises like this.

On a related note, today we had a "communication skills midterm" with a standardized patient. We took a medical history, paying particular attention to building rapport, eliciting information, and respecting the patient. Then we had to come up with a differential diagnosis for the symptoms, which I found very difficult. That's definitely something I need to work on from now until my third year.