Am I alone in perceiving a large gap between what the 'evidence' says and what
happens in the real world. I am particularly conscious of this in the management
of hypertension where a pitifully small proportion of my patients seem to be
consistently well- controlled. This means that they all trail back to see me
with monotonous regularity whilst I battle away with their weight, side-effects,
poor ( and to be honest understandably so) compliance etc.etc. They now feel ill
and are terrified by my failure to control their problem.
And now we are exhorted to get the diastolic down to 85 or so. Geez a break!
There was a paper in the college journal a few years ago which showed that older
docs paid less attention to raised BPs. The usual suspects were rounded up -
more education, training, personal development required bla bla. I think these
results simply reflected the experience of older GPs and their ability to temper
guidelines with a 'holistic' approach e.g. Wee Jeanie is already a nervous wreck
and thinks she is dying. If I start treating her BP of 165/95 we are both going
to have a bloody awful time in the next few years. - Aw stuff it!!
Ian
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