My most hated CC is Hypertension, hands down. I don't understand how nobody has put out a PSA yet regarding this. I literally see this 2-3x/shift. There is nothing that causes more facepalming on my end and anxiety on the patient's end than hypertension. I have found that it is much easier to deal with in a poorly educated population, much like the population I saw in residency. Now seeing a largely educated, wealthy, elderly population in the community, every single one of these people has a cardiologist they demand you call because they know better than the dumb ER doctor. Theoretically this population should be much easier to deal with, as they have clear ability to obtain close f/u (all of them have their cardiologist on speed dial...I wish I were joking). The conversation with the most anxious of these type usually goes something like this:
Me: "I understand the concern, but fortunately for you high blood pressure w/o symptoms is not something that is going to harm you in the short term, in fact, trying to abruptly bring your BP to normal can potentially cause a stroke. It is important to get your BP under control, however, this should be done over weeks in conjunction with the doctor managing your BP. What I would recommend is taking your BP meds as scheduled and f/u with your PCP tomorrow to discuss your BP management and refrain from taking multiple BP measurements at home as this will only lead to increased anxiety."
Pt: "So you aren't going to do anything for me? I need you to call my cardiologist because this BP is not normal for me."
Me: "Ma'am, I would recommend you call your cardiologist yourself tomorrow morning to set up an appointment. There is no reason to get someone out of bed for this. You have no symptoms, you are safe to wait a few days until you can get in to see him/her. Isolated high blood pressure while seemingly scary, poses no immediate threat to you if you are not having symptoms."
Pt: "So you are just going to wait until I have a stroke to do something? Are you really a doctor? My daughter is a nurse and even she knows that BP should not be this high."
Me: "Ma'am, as I stated earlier, abruptly lowering your BP could potentially lead to the stroke you are so fearful of. You need to get in with your doctor to adjust your HTN meds as the ER is not the right location to be toying with your chronic meds."
Pt: "Do you have a boss?"
Me: "I have no boss."
Pt: "Well I would like to speak to a patient advocate."
Me: "Ma'am, it is 11 o'clock at night, there is not a patient advocate here in the hospital at this hour. What I would suggest is to go home, go to sleep, and then go see your doctor; however, if you are adamant about talking to someone, you can speak to our charge nurse; however, she has no say on how I deliver medical care."
Pt: "I want another doctor."
Me: "I am the only doctor here. If you would like to see another doctor, feel free to wait in the waiting room until 6am. You can also go to another hospital if you feel that my care is not appropriate; however, understand that you will be billed for two separate ER visits and you are unlikely to get a different response."
Pt: *Pulls out phone* "What is your name?"
Me: "Dr. Zebra Hunter, that is Z-E-B-R-A."
Pt: "I am going to write a formal complaint about you, and I will never be coming to this ER again." (I've never understood why people think we will be upset about this)
Me: "Well I am sorry you feel that way. You will be discharged now."
Pt: "Screw you!"
.....scribe who has been standing in the corner the entire time turns to me as we are leaving the room: "Diagnosis of 'anxiety about health'?"
Me: "Please."
*5 minutes later*
Charge nurse: "That anxious hypertensive lady is refusing to leave."
Me: "Tell them you are calling security to escort them out if they are refusing to leave, but I will not be returning to that room."
