Opinion: Losing Touch With Patients
May 23, 2001 -- There's no question that high blood pressure is a problem in our society that's both highly concerning and highly prevalent. Appropriate treatment depends on accurate measurements and I applaud any technology that inexpensively and conveniently improves the ability to gather accurate information.
But accurate information is often about more than just numbers. For instance: There is a story currently on WebMD about a home electronic device that a patient with high blood pressure can use, twice a day, to monitor their blood pressure. The proposed advantage to this device is that it can then transmit that information over the phone, by modem, to a central computer. The data is then sent to the appropriate doctor.
The device is being hailed as a major breakthrough in home monitoring because doctors can "call in prescription changes without requiring an office visit with the patient." In an age where doctors are more pressed for time, that is very convenient. But, I think we need to be careful to consider this device and its proposed benefit.
First off, there is a monthly fee for the patient to use the device. And second, even if the device is a more accurate home monitor, does that really replace the need for a visit with the doctor? After all, there is more to being a doctor than just reading data.
My concern is that doctors are at risk of losing touch with their patients. The people we care for are more than just blood pressure readings and prescriptions. Many factors contribute to blood pressure. Case in point, I recall a former patient of mine with difficult to control blood pressure. On or about the second office visit, while getting to know her better, I discovered she was a victim of spousal abuse.
Needless to say, that kind of "data" wouldn't have made it over a modem. We were able to eventually stabilize this women's blood pressure with medication, but we were also able to help stabilize her life with the help of the social service department.
True, this is perhaps an extreme example. But even on a more mundane level, just calling in a medication doesn't allow the opportunity for discussion and education. I am not here just to tell you, the patient, what medication you should take; I am also here to teach you about your disease, in this case high blood pressure, and present you information on the many possible therapies.
Most of the treatments will center around medications, but not exclusively. In fact, much of high blood pressure can be controlled with improved diet and regular exercise, although this method is not for everyone. Any treatment can take time, and first and foremost, it is important to get blood pressure under control. So I advocate starting on medicine, and backing off then if other treatment factors demonstrate their effectiveness.