Tuesday, April 12, 2011

A very interesting Blog

Shifting the bell curve

The nurse at my doctor's office was checking my blood pressure last week when the following conversation ensued:

Nurse: (trying not to look worried) Um, have you ever had low blood pressure before?

Me: No. I've always had normal blood pressure.

Nurse: (now not hiding worry) Well, I'm getting 100/70 for you.

Me: Yep. Perfectly normal.

One of the residents today was telling me about a code he attended in the hospital yesterday. The code was called for hypotension (dangerously low blood pressure). The resident rushed into the room to find the patient sitting calmly, eating his breakfast. The nurse informed the resident that the patient's blood pressure was 90/60.

My intention here is not to lambaste nurses. They are merely following their protocols and experience. The larger question, I think, is when did reasonable blood pressures become "low"? Is it just because most of the blood pressures that nurses (and docs, for that matter) see are elevated?

I can't separate the word "normal" from the picture of a bell curve in my head. And I have to wonder if the bell curve for "normal" blood pressures isn't starting to shift toward the right.

I don't like the complacency toward a new norm that these events portend. How can we convince our patients that their blood pressures are too high when the bell curve of normalcy has shifted? I have started using the word "healthy" to describe desirable blood pressures instead of "normal."

Because, sadly, normal doesn't seem to be healthy anymore.

Laurence Bauer, MSW, MEd

Chief Executive Officer

Family Medicine Education Consortium


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