Is this clinical?

[AttemptingScholar]

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I am part of a club that goes to medically underserved communities and gives free blood pressure tests. It's certainly "close enough to smell the patient" but isn't in a traditionally clinical setting.

If the point of clinical experience is to help patients or see how any part of the health system works, then it is. If the point of clinical experience is to see how clinical environments helps patients, it isn't. Thoughts?

 

[Nave]

Yes

 

[LizzyM]

Do you refer to them as patients when they come to see you? To me, that is always the first test.

This is a good exposure to people who are seeking help and being proactive about their health. It might be in a community/culture which you would otherwise know little about so it may be educational for you in that way. It is giving you the opportunity to practice a clinical skill and practice communicating with patients and making protocol driven decisions about how to proceed when a BP is exceptionally high (refer to usual care provider, refer for emergency care, call 911).

It should not be your sole clinical experience. You should also have something (shadowing, working, volunteering) that puts you in proximity to physicians and give you some idea of what they do all day.

 

[sullen-burger]

I am part of a club that goes to medically underserved communities and gives free blood pressure tests. It's certainly "close enough to smell the patient" but isn't in a traditionally clinical setting.

If the point of clinical experience is to help patients or see how any part of the health system works, then it is. If the point of clinical experience is to see how clinical environments helps patients, it isn't. Thoughts?

Yes it's clinical and

For the love of god, if they haven't already told you to do this, take a BP on both arms to check for a possible aortic dissection, oh and also peripheral artery disease. heart defects, kidney disease, blocked arteries, diabetes.

Who recommends this? Most cardiologists. Harvard. Mayo Clinic.

Big arm-to-arm difference in blood pressure linked to higher heart attack risk - Harvard Health Blog

 

[LizzyM]

Yes it's clinical and

For the love of god, if they haven't already told you to do this, take a BP on both arms to check for a possible aortic dissection.

Who recommends that?? It would be very low yield... The incidence over a 10 year period in a British population was 6 per 100,000 (confidence interval 4-7).
Population-Based Study of Incidence and Outcome of Acute Aortic Dissection and Premorbid Risk Factor ControlClinical Perspective | Circulation
It is recommended that BP be measured at the first visit in both arms and it is very common that there is a difference between arms but the reason for the difference is very seldom aortic dissection.
see:
Accurate Blood Pressure Measurements and the Other Arm: The Doctor is Ultimately Responsible

 

[AttemptingScholar]

Yes it's clinical and

For the love of god, if they haven't already told you to do this, take a BP on both arms to check for a possible aortic dissection.

Unfortunately, the communities are not at a point where it's a priority. 🙁 We focus more on nutrition and healthy living, and our referrals (informal, obviously) are to free clinics which specify that you do not need insurance or papers to attend! Hopefully, we'll get to the point where we can make catching rarer things like that a priority, but it's gonna take a while.

 

[sullen-burger]

People walk around with dissections and never know it until they die. An additional 2 minute test is absurdly

Who recommends that?? It would be very low yield... The incidence over a 10 year period in a British population was 6 per 100,000 (confidence interval 4-7).
Population-Based Study of Incidence and Outcome of Acute Aortic Dissection and Premorbid Risk Factor ControlClinical Perspective | Circulation
It is recommended that BP be measured at the first visit in both arms and it is very common that there is a difference between arms but the reason for the difference is very seldom aortic dissection.
see:
Accurate Blood Pressure Measurements and the Other Arm: The Doctor is Ultimately Responsible

Physcians. AHA. Cardiologists.

The fact that the condition is rare is a given; that doesn't mean a simple method to help catch it and other diseases shouldn't be used, in conjunction with the slew of other symptoms and findings assessed during the physical exam.

 

[LizzyM]

People walk around with dissections and never know it until they die. An additional 2 minute test is absurdly



Physcians. AHA. Cardiologists.

The fact that the condition is rare is a given; that doesn't mean a simple method to help catch it and other diseases shouldn't be used, in conjunction with the slew of other symptoms and findings assessed during the physical exam.

A dissection kills in a matter of hours, maybe days at the most. 96% of patients have symptoms and in 90% the pain is often severe at outset.

It makes no sense to screen asymptomatic people in the community for aortic dissection.

There is evidence that taking BP in both arms once at an initial intake exam makes sense but not every time blood pressure is checked at a community event.

 

[sullen-burger]

It makes no sense to screen asymptomatic people in the community for aortic dissection.

You're not saying anything that goes against what I'm saying. Were not disagreeing.

Oh and even if you're at a community event you can recommend someone visit the ER based on xyz.

 

[AttemptingScholar]

You're not saying anything that goes against what I'm saying. Were not disagreeing.

Oh and even if you're at a community event you can recommend someone visit the ER based on xyz.

While I admire your enthusiasm for comprehensive health care, it just doesn't quite fit the situation. We're 2-3 premeds, often I'm the only one who speaks Spanish (and let me tell you, I do not speak it well!) with a community that often has no English. I, at 19, am often the oldest person working there. Our events are not based around healthcare, we set up a table at events where people go to get passports or other legal documents updated and some people chose to stop by us.

In these circumstances, someone could have 140/90 (which we've had) and WE ARE NOT ALLOWED TO DIAGNOSE HYPERTENSION. Our role is incredibly limited.

Even if I could somehow explain in a language I barely speak that I want to take it from both their arms (which I've never had a doctor do to me, by the way), I would probably do so to check for atherosclerosis, not aortic dissection (same indicator of different bps in different arms, way more common, doesn't often reveal itself by immediately causing a medical emergency).

Try as I might, I'm not a doctor yet. Our role is to check for high (or occasionally low) blood pressure and refer them to a free clinic. I can't just randomly decide to also check for an incredibly rare disease that I've had no training learning to spot. I'm young, but I hope I'm mature enough to realize that my current role doesn't come close to actually being a doctor.

 

[sullen-burger]

While I admire your enthusiasm for comprehensive health care, it just doesn't quite fit the situation. We're 2-3 premeds, often I'm the only one who speaks Spanish (and let me tell you, I do not speak it well!) with a community that often has no English. I, at 19, am often the oldest person working there. Our events are not based around healthcare, we set up a table at events where people go to get passports or other legal documents updated and some people chose to stop by us.

In these circumstances, someone could have 140/90 (which we've had) and WE ARE NOT ALLOWED TO DIAGNOSE HYPERTENSION. Our role is incredibly limited.

Even if I could somehow explain in a language I barely speak that I want to take it from both their arms (which I've never had a doctor do to me, by the way), I would probably do so to check for atherosclerosis, not aortic dissection (same indicator of different bps in different arms, way more common, doesn't often reveal itself by immediately causing an emergency).

Try as I might, I'm not a doctor yet. Our role is to check for high (or occasionally low) blood pressure and refer them to a free clinic. I can't just randomly decide to also check for an incredibly rare disease that I've had no training learning to spot. I'm young, but I hope I'm mature enough to realize that my current role doesn't come close to actually being a doctor.

Obviously you can't diagnose. I never told you to diagnose anything so much as a cold.

Will you have any actual health professionals with you?

 

[AttemptingScholar]

Obviously you can't diagnose. I never told you to diagnose anything so much as a cold.

Will you have any actual health professionals with you?

No

 

[sullen-burger]

No

Then I rescind my original statement. I no longer think this is a clinical activity if there's no supervision.