I went to the doctor yesterday, my semi-annual visit, as it were. These days I see a nurse practitioner, a woman. Recently, she and the practice she is a part of moved into a renovated building, state-of-the-art, they are calling it. It almost sparkles in its newness. The practice is owned by one of the large hospital corporations in our city.
See if what follows sounds familiar. I am led into one of the examination rooms where I sit for a short time before a nurse’s aide appears, a pleasant enough young woman. We chat for a bit, small talk about nothing important. She then asks that I sit on the end of the examination table where she takes my temperature (normal) and puts a device on my finger to measure my pulse (slightly rapid), and then, most important of all, she takes my blood pressure. I stick out my left arm, per her request, closest to the wall where the blood pressure gauge is attached, my feet dangling off the edge of the examination table. I don’t say what I am thinking at this moment, but wait until she is finished, and then say, “You’re doing this wrong.” I tell her how studies indicate, according to an article I read in the medical section of the New York Times, that when taking blood pressure, the patient’s feet should be flat on the floor, and the extended arm resting on a solid surface, such as a table.
This is especially important when dealing with the elderly, and at 73, I certainly qualify. Done incorrectly, blood pressure levels can be skewed, as much as 14 points on the high side. So persons with normal blood pressure can leave the doctor’s office with a prescription for medicine — which sometimes becomes a lifetime order — when, in fact, there is no such need. Of course, these medicines are not without side effects. When you think about it, not such a small matter, which I broach this morning.
The young woman says nothing about my remark, but the expression on her face tells me she is not impressed. Indeed, she may not believe me. “Stupid old man,” she thinks, “What does he know?”
I take medication for blood pressure, and have for years, and this day, my blood pressure is elevated. It often is, when measured in doctors’ offices. At home, I monitor my own blood pressure. I have an apparatus, and it usually is fine. But increasingly, I am wondering if I have ever been evaluated properly for my blood pressure problem. I am not sure I have, not that I am saying I am without a blood pressure issue.
In the past ten or so years, I have gone to four different doctors, looking for one that suits me, I suppose. One lady moved to California, but she too took my blood pressure as I just described, incorrectly.
Another doctor, this time a man, kept commenting upon the fact that when he ordered labs, usually blood work, I took his order to an outside lab and not to his in-office lab. He too, by the way, was owned by a hospital conglomerate. After the third time, he sort of scolded me on this issue, noting I was the only patient in his large practice to do so, so I dropped the sucker, and went elsewhere. His assistant also took my blood pressure wrong and she was quite unfriendly.
At my next stop, I found no more satisfaction. This doctor’s assistant had me on an examination table as she took my blood pressure, feet dangling, and the rest. I didn’t say anything to her — actually, I’ve never spoken up until my most recent experience — because she was adorned with tattoos, and while she may have been competent overall, I could not get beyond those friggin tattoos, up and down her arms, and who could say where else. They became a deal-killer for me, but that is just how I am, I guess. I figure anyone to cover herself with tattoos could not possibly gain my confidence as a medical person. I never went back.
So now I am here seeing my current practitioner, number four. Their offices are very close to my home. In a word, convenient. So I see my main person, the nurse practitioner, a tall, thin woman who looks rather athletic. She is dressed casually — no white coat for her. After we deal with other business, several lab results I needed to give her, I mentioned the blood pressure topic and my concerns. She agreed totally with what I said.
“The blood pressure apparatus ought to be on the other side of the room,” she says, “where there is a table and chairs.” Does this mean a change in their procedures is about to be initiated because of what I had to say? I didn’t ask that question and she did not offer that such a change would occur. Indeed, my nurse practitioner may have been humoring this old man sitting across from her. But more importantly, she likely has no power as a nurse practitioner in a practice made up of men and owned by a large hospital company.
You have to wonder, though, if my criticism were to reach a more powerful person with the company, and likely a man, would the result be any different? Would the young nurse’s aide be retrained? Doubtful. Would the hospital company itself be willing to go into multiple examination rooms and revamp and reconstruct, redesign what is already there? You don’t have to be as cynical a person as I have become to know the answer to that question. It is a resounding no.
So what conclusions must I as a patient draw? Perhaps that the health system I deal with in Louisville cares about my health (and that of others) to a certain degree, yes, but there are definite limits to these concerns, especially if they involve time and trouble and some expense. What else can I conclude?
“So what next did I do?” you ask. Not much. I went home and found the New York Times article about blood pressure studies, and I sent it on to my nurse practitioner. But if I were a betting man, and I am sometimes, I would give odds on a wager that says that when I return to the clinic in the fall, nothing will have changed, and the subject will not be brought up, unless, of course, I were to do so.
Funny how that is. Maybe funny is not the word I should use. Perhaps “sad” is more appropriate.
Raymond Abbott is a social worker.
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