Tag Archives: hypertension

Treat the patient, not the numbers

In Oriental Medicine and in Homeopathy, we would not run any laboratory tests before treating a patient.  Information was solely gathered by physical observation and the interview process.  So detailed and careful were those exams that they put Allopathic Medicine (“Modern Medicine”) to shame.  So, by the time I studied Allopathic Medicine in PA school (22 years ago), I was ready to learn that observing the patient in front of you is often more important than a measurement or lab test.

Below are a few classic examples:

High Blood Pressure

At my first job out of PA school in an ER, providers will still treating high blood pressure reflexively.  If a patient’s blood pressure was high, they popped a few pills into the patient to bring it down to “normal” quickly.  I had learned that such a practice was dangerous but it took me three months to get the ER staff to change their old habits.  If someone has had high blood pressure for a long time, they probably need that pressure to keep both their heart and brain perfused with blood.  We now know that lowering chronic hypertension abruptly can lead to ischemic disasters.

Low Oxygen Levels

Pulse Oximetry is a gentle finger clamp that uses a laser to measure how much oxygen is in your blood.  When these first came out, if someone had low oxygen levels, they reflexively supplemented their oxygen with an oxygen mask.   But ironically, if a pt has acute exacerbation of  Chronic Obstruction Pulmonary Disease (COPD) high levels of uncontrolled oxygen can result in respiratory failure!  For unlike healthy patients whose respiratory reflex is triggered by high CO2 levels, in these patients it is low O2 levels that trigger the response which you can blunt by supplying uncontrolled oxygen – thus ironically killing someone using oxygen.  This problem was later solved with special delivery systems.

High Temperature

The old school ideology was that body temperature needs to be brought down to normal range.  In Japan and China, a person with a fever is made to sweat more — their high temperature is raise further.  The body produces a fever to kill bacteria.  It is true that only some organism are killed or slowed down by high body temperatures and that the response is non-specific, but you should usually give fever a chance to work.  But in the ERs where I first worked, nurses would not give blankets to patients with fevers even if they had the chills in fear of raising their temperature.  And they would always give Tylenol or Motrin for any temperature over 100 deg C.  It took me 1 year to get that practice changed.  I had to print out article after research article and finally present them to the medical group.

Well, those are only a few examples to a principle which I will quote in an up-coming post.

____________
Related Posts:

12 Comments

Filed under Medicine