Here is a question for you:
A 55 y old male with HTN is here for follow up. He has no other medical problems. Medications include losartan, metoprolol, amlodipine,
and HCTZ. Blood pressure is 160/100 mm
HG. What is the next best step for his
blood pressure control?
A.
Dietary history
B.
Check Renin/Aldosterone levels
C.
Check secondary workup
D.
Make sure the patient is taking all medications
properly
E.
Obtain a 24 hour ABPM
Any of the above or all of the
above would be good choices and one can start with either one. Here are the
real world choices…
A.
Obtain Renal consult
B.
Obtain Endocrine consult
C.
Obtain Cardiology consult
Here is where the fragmentation
begins. Why does this happen?
Here are the top reasons in my
opinion
Not enough time to think
Inertia to think
Patient satisfaction( I want a HTN specialist)
Training not adequate
Trainers were not master clinicians and hence they believed in panconsultemia as well
Inertia to think
Patient satisfaction( I want a HTN specialist)
Training not adequate
Trainers were not master clinicians and hence they believed in panconsultemia as well
Once consults are obtained: - more
confusion as cardiology and nephrology don’t agree on drug choices. Endocrine
wants more tests. Now more accidental findings…. And it continues.
Welcome to medicine in 22st century.
Let’s please stop this madness!!
Welcome to medicine in 22st century.
Let’s please stop this madness!!
No comments:
Post a Comment