elocs

I've been treated for hypertension for years and at times I've been amazed at the results. At one clinic they allowed me to stop in routinely to get my bp checked. One time I got stopped for speeding just blocks from the clinic and the cop gave me a warning and I was sure my bp would be high, but no, perfectly fine. Another time I felt great, relaxed and no stress, and it was high.
A few years ago I rode my bike 5 miles to my annual physical and got there plenty early so I could rest. They gave me a beeper and within 5 minutes they had called me into the exam room and immediately checked my bp which was not "high" but higher than it should ave been on medication. My doctor of 10 years told me the next time after that I saw him that he was leaving and 1 of the reasons was like my case when my bp was high because I hadn't rested. Because part of his pay was based upon the results of the patients he was treating and since I had been under his care for years for bp and mine was higher than it should be, he got marked down negatively for my results. He understood the reason it was high at the time and was not concerned but he should have played the game and sent me out to sit for 20 minutes and then took it again, but he just didn't like that.

This same doctor had me on Atenolol as one of the meds for my hypertension. It's a med that slows your heart rate and so lower your bp. Now when you are on a med for years you just become used to how you feel unless you have terrible side effects from it and I didn't have them as a rule. One time I rode my bike a mile to the mall to have my bp check at the machine in the pharmacy and even though I only sat for 5 minutes my heart rate was just 49--terrific for an athlete in great shape, but that was not me.
Atenolol lowered my heart rate and kept it there, even when riding my bike but in my flat city that was never much of a problem except when I had to ride over a railroad overpass, the only real hills in the city, and I was dying when I got to the top. My lungs were screaming, "More blood! More blood!" but my heart was replying, "Nahhh, I don't think so".
My next doctor after the previous one left told me after my first physical with him that Atenolol was no longer considered a first line med to treat hypertension. A month later I emailed him and told him I would like to taper off it and he gave me a schedule on how to do it. Well as far as cycling goes, getting of of Atenolol was a life changing experience for me because I could now go over those overpasses, even pulling an empty trailer, and I would be tired at the top but not dying and out of breath and needing to stop and rest. My heart rate became normal and my heart was able to beat faster when I needed more blood like when exercising. The doctor replaced the Atenolol with a water pill and my bp is just fine. Maybe somebody else might learn something through my experience.

Speedskater

Ah, beepers and blood pressure. I saw the sports cardiologist at the Cleveland Clinic main campus. The waiting room is huge and you get a beeper. So my blood pressure was way up as it always is in doctor's offices. But I had my 36 page, 30 year blood pressure log book with me. He said come back in two years.

Retro Grouch 

There's lots of variables in the way blood pressure is commonly taken. Depending on who is taking it and the detailed methods they use, my blood pressure will vary from 120 to 180. That's a lot of difference. I'm wondering just how reliable a measure blood pressure is.

McCallum

Here is the problem, I sit in the waiting room till just about my appointment time. They take me back do the weight, height and the like. Sit me in room where I sit for 30 plus minutes getting madder and madder that I had a 1pm appointment and it is now 1:30, then 1:45, then 2:00 when the doc walks into the room takes the BP to check what the Nurse got. BP then is higher than when nurse took it. all because 1) white coat syndrome and 2) they have no concept that my time is as valuable (or more) then theirs.

bobwysiwyg

Sounds so familiar. Many can't do this, but I tend to be an early riser. I schedule my appointments for 8:00, their office opening time. In my experience, the later in the day your appointment is, the more slippage in their schedule.

canklecat

Ditto, the recommendation to schedule your appointments as early in the day as possible if you don't want to be delayed.

Schedule delays are unavoidable some days, particularly in clinics that specialize in geriatrics and aging patients. Many patients have complications that prolong what should have been a "routine" visit. I've seen it many times as caregiver for both grandparents and my mom. We'll show up for a routine appointment, the doctor will discover potential complications and it takes time to set up referrals to appropriate specialists, diagnostics, etc.

Administrative burdens required to satisfy various laws add to delays. If the clinic is in a teaching hospital there may be delays due to redundancies as the nurses, doctors and specialists are accompanied by trainees.

Since my mom is in an electric wheelchair and we need a larger van or small bus to transport her we use city's mobility impaired transportation service. This adds two hours for the round trip, since the bus service needs a buffer to accommodate other passengers with special needs, especially those who don't have an attendant and need the driver to help the client.

So my mom's "routine" appointments are usually half-day or all-day affairs. It's a half-day if her appointment is early in the morning when the clinics tend to run on schedule. But she's very difficult to get moving in the morning, so with appointments after noon the scheduled 1 pm slot usually means 1:30-2 pm. On the plus side, her doctors are less rushed in the afternoons and take more time to listen to her. That's a good thing since dementia has impaired her ability to think and communicate quickly, so she's less frustrated and upset when nurses and doctors don't rush her. I've actually seen mom break down in tears when a time-constrained nurse tried to impose rapid fire questions in the name of efficiency to meet deadlines for early morning appointments.

So, if you have no special needs or complications, are completely independent and prefer maximum efficiency, schedule all medical appointments for as early in the day as possible.

McCallum

Oh I have; if lucky they get you back in the room at 8:15 and you still do not see the doc till 8:45

Here is my thing for this is unavoidable; BS! The doctor etal know this will happen and therefore it can and should be built in to the days plan but hey if we build reset time into the we may just lose money and HEY the people have no choice but to come and see the doctor so they are going to come whether they get in at the time of their appointment or have to wait an hour after the appointed time.

For me, Doctors get upset when I am late for the appointment; if you time doctor is important so is mine. When I check in the staff that checks me in KNOWS they are [insert amount of time behind here] tell me with an apology. I might have something else I can do while I wait in the building.

ALSO here is the number One reason they are behind; Back in the day before HIPPA they were not as protective of letting a person see the appointment book. I was making a appointment for like 8isha.m. I happened to see that the time they offered me already had a name in it yep two of us were seeing the same doc at 8:15. I asked how the doctor was going to see me and the other person at the same time! They gave me the BS about how people do not always show up and the like. I asked well if we both are here, how is he going to see us at the same time?

canklecat

You can eliminate most delays, but it costs more.

I've seen specialists who do not overbook patients. But they will charge patients the full amount, including when patients are late, miss appointments or want to reschedule after a deadline has passed.

The neurologist I saw years ago operated that way. No nonsense, no excuses, no delays. He was very expensive.

It's available for folks who can afford it and pay everything in cash.

For the rest of us on Medicare, most insurance plans, etc., redundancy, overbooking and delays are par for the course.

DougG

A doctor I used to go to would try everything he could think of to get a low reading on my BP, such as taking it multiple times, waiting another few minutes, etc. But that makes me wonder how that's supposed to help me. If my BP is at an acceptably low level only under exceptional circumstances, how many times a day will it be that low? A more meaningful reading, IMO, would be to have more of an average reading during a normal level of daily activity.

Of course there's no way to do this that I know of, but it would seem to be the right way to tell how much overall BP stress my system is experiencing.

elocs

It doesn't necessarily help you, but it helps your doctor because if he is treating you for hypertension then it can be the case where his payment by the hospital or clinic for treating you is based upon your BP being good during a visit.
I had a doctor I had seen for over 10 years a few years ago who was treating me for hypertension. I had an annual physical where I rode my bike 5 miles to get to the clinic, getting there early so I could sit a rest for a good half hour before my exam. But low and behold they hustled me right in after having sat for maybe 5 minutes and took my blood pressure which was not bad but neither was it good for being on a couple of BP meds. But I had not really rested enough even if I had only walked from the car much less having ridden my bike there. My doctor told me that he was reimbursed by the clinic based upon my BP results at the time of my visit which he felt was not fair and was the reason he quit that clinic later that year. My next exam with him was in his last week there.

Myosmith

Blood pressure is very labile and changes throughout the day. Activity, anything you eat or drink, stress, talking, the amount of sleep you got last night, pain/discomfort, you name it, it affects heart rate and blood pressure. Add to that the fact that sphygmomanometry (taking a blood pressure) isn't as precise as it could be. Unless you use the exact same cuff and machine every time, there will be variations. Even the same practitioner taking manual measurements with a stethoscope will have some variation from one attempt to the next.

Actually, spot checks are of limited value as they are only a snapshot of your approximate BP at a given moment. Also of limited value is the lowest BP you can get to at total rest with no physical, chemical or mental stimulation (how often during the day are you 100% relaxed and at rest?). More important is the average of your BP throughout the day. Obviously continuous monitoring is not practical except in a hospital setting, but having your BP taken several times at different times of day will give you a better picture than a single spot check. For example: if I get a good night's sleep, skip my morning coffee, don't exert myself physically or mentally, and sit quietly thinking about my happy place for 15 minutes before they take my BP, I might get a very good reading, but what does that have to do with my BP in the real world? Not much.

gregf83 

Guidelines for BP are based on studies where they look at the correlation between heart disease and BP. If you want to compare your BP to recommendations from a particular study you should use the same protocol as the study. If a study takes an average BP based on multiple measurements during the day then that would be appropriate. If, however, a study measures BP while a subject is rested before having coffee in the morning then comparing that to average measurements taken during the day could give misleading results.

Myosmith

Agreed, but what I was trying to point out is that single spot checks are only small windows into the big picture. Since there are many factors that affect blood pressure and your blood pressure can vary quite a bit day to day or even hour to hour, getting one good or bad reading (such as at an annual physical) doesn't give you enough information. What good is it to get a "good" reading while well rested and decaffinated, if the other 90% of your life involves caffeine-fueled long, stressful hours where you rarely sit still followed by short, fitful nights.

elocs

I've never had a physician judge my blood pressure on one good or bad reading. In fact when I first showed signs of hypertension in my middle 20s at a yearly physical my doctor told me he was not going to diagnose me as hypertensive based on a single reading but that I should try and lose some weight, stop at the clinic over the next month and a nurse would take my BP, and then stop back and see him. I lost the weight (how easy that is to do in your 20s, but it was only about 15 pounds) and my BP went down to normal.
After not having health insurance through my 30s I never went to see my doctor because I felt fine. Then I injured my back at work and it was going to require surgery and this same doctor told me that my BP was elevated to the point where they would not do the surgery unless I got it down. That's when I started on the BP meds and it's taken a lot of years to really hit on a combination that would work long term as sometimes 1 would work well and then peter out and another would need to be tried. But those years when I had untreated hypertension took a toll in that I now have kidney disease but at least my kidney function is in the 50% range, as good as if I only had 1 kidney. The key now is to keep the BP down.

DiabloScott

It's very unlikely that someone with BP problems would get even a single "very good reading". Annual spot checks are just a screening tool. If you have some high readings, THEN it would make sense to watch how it changes with time of day, caffeine, and exersize.

I'm usually borderline in the doctor's office, but I have my own cuff and I know I'm well into normal range and my doctors believe me. One doctor takes it once while seated and then again after I stand up.

With the potential new guidelines though, 120/80 starts to be a risk factor so that's going to be a LOT more people.

Myosmith

I agree with elocs and DiabloScott in that it usually isn't a physican or other health care professional who makes a judgement off a single reading. More often it is an individual who avoids the doctor and only gets checked infrequently such as for an annual DOT physical (for professional drivers) or at free spot checks at public events. All I'm saying is that one or two infrequent checks, especially when you have done advance preparation such as avoiding your usual caffiene or getting extra rest the night before, is not adequate to assess your real world blood pressure and its affect on your health. Maybe I shouldn't have used the term "very good reading" but there are plenty of people who can get a reading in the normal range, through luck of the draw or intentional manipulation, who are actually pre-hypertensive (a term that is going away with the new recommendations) or hypertensive most of the time.

labile: a quality of being easily and frequently changed, unstable

DiabloScott

Thanks, from a linguaphile!