In article <001b01c420a4$74f0a5b0$6700a8c0@jonathanrcb8up>, Jonathan
Reggler <[log in to unmask]> writes
>Slightly tangential, but in Canada a surprising number of patients with
>hypertension have their own sphygs, with cuffs for the upper arm (haven't
>seen a wrist one here).
>
>In patients in whom I suspect a white coat effect, I encourage them to bring
>their machine to their next visit. If it reads pretty much the same as my
>mercury sphyg (mercury tested first to prevent unconscious bias on my
>part) - within 5mmHG - then I agree to use their home readings, which are
>generally quite a bit lower than in the office.
>
>The alternative is for patients to bring in readings from the drugstore
>sphygs which I have decided (arbitrarily) to regard as properly calibrated
>(it being no more or less likely than my mercury being accurate). I find
>the white coat effect to be much commoner than perhaps most of us realise,
>and this is a simple way to remove it. It also speeds things up seeing
>those with an established WCE. We just review their own figures rather than
>faffing around with readings of questionable use in the office.
>
Me too. And more importantly, I do it because I want to rather than
because someone says I have to to get paid. I would also echo the
sentiments regarding the influence of pay being tied to targets on what
gets recorded. I love not working under that influence.
Cheers
--
Jelly Bean
The Wilderness Emerg Medical Tech course and Command Physician site has been
updated - take a look for course dates in 2003!!
http://www.wildmedic.org
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'When you get fed up surfing....
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