I had a lightbulb moment the other day. It was immediately after a consultation you and I have experienced countless times before. You know, the one involving the patient with hypertension who micromanages his home blood pressure monitoring, who gets headaches from his calcium blockers, who interprets this as a symptom of hypertension, who gets anxious as a result, who chooses that peak-stress moment to check his blood pressure, who predictably finds it’s a bit up, who books an emergency appointment because obviously this means he’s about to have a stroke, whose anxieties and misconceptions take an age to unravel and resolve and who, as he’s leaving, says, ‘So could you just check my blood pressure?’
Sigh. It made me think, what’s the point of all this? I don’t mean life, or even those endless hours banging our heads against the coalface. I mean specifically, blood pressure. The whole hypertension thing. Sometimes – as in nearly always – it just seems to create a massive amount of work, hassle and angst.
And that’s when, thanks to a DNA giving me some headspace, I had my epiphany. Because it occurred to me that, if patients overvalue the concept of blood pressure, then so do we GPs. Have you ever thought about why we measure it at all? I mean, really thought? Yes, I have heard of infarcts, strokes, CKD and so on, and I realise there’s some association with hypertension. I’m not an idiot.
But who had the idea of measuring blood pressure in the first place, and why? Why did we all assume it was relevant? Is it because it was just something we found we could do, and it impressed patients? Would we have obsessed about it if it’d been less accessible? If we could easily measure intraocular pressure or cerebral electrical activity or faecal magnesium, would they have developed the iconic and industrial significance of blood pressure? Is blood pressure actually the issue or is it just a marker for something else? Am I going to have a cerebrovascular accident just thinking about all this stuff?
Maybe it’s all black magic and we are little better than swivel-eyed homeopaths
…were just some of the questions that popped into my head. And then I realised: you could easily extrapolate this existential angst to most of clinical general practice. Probably all of it. We diligently apply the prevailing wisdom/guidelines/QOF targets, but when you step back and think for a moment, you realise it’s all just dogma, isn’t it? And it’s adhered to because we’re too exhausted, arrogant or medicolegally anxious to admit that, while we’re probably doing our best, much of what we do is self-justification and little of it is likely to alter what would have happened anyway.
In short, maybe it’s all black magic and we are little better than swivel-eyed homeopaths.
So that’s my insight. We know nothing. Or rather, as many have said before, everything we know is wrong (except that quote, obviously). So this year’s PDP is going to be just huge.
Anyway, for want of anything better to do, I checked my own blood pressure. It was 135/85. I have no idea what that means.
Dr Tony Copperfield is a GP in Essex