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How to Fail at Building a Relationship with a Patient, or, This is How Professional Fitness Cheerleaders Discourage People

May 31, 2011

With the current car-free situation, I have been walking at least 2.5 extra miles each day, often more. This is objectively good for me – as long as I avoid cars that don’t bother to stop for pedestrians and too much sun. It’s a positive thing.

Based on my recent experience with folks whose job it is to motivate people to be healthier, I should just be worried and OMG and am practically about to drop dead. Because my blood pressure was 120/70.

No, really. It was a weight and blood pressure check thing, and I was curious about whether the walking had changed my weight any. I should have known better. I already know what ZOMG-GONNA-DROP-DEAD! BMI category I’m in. So this lady looks at my weight, and immediately asks, before the blood pressure cuff even went on, “Do you have any problems with hypertension?” You know, ’cause I’m fat.

I told her no. She took my blood pressure, which was respectable. Especially after this lady’s attitude. Did she ask me if I’d taken any cold medicine or other drugs, like birth control? If I’d had a high sodium meal? If I was a smoker? Did she take a second measurement? Nope. She just told me repeatedly that the top number, 120, was “right on the line.” That’s right on the line of the lowest value of possible “prehypertension,” by the way.

It’s true that the current guidelines now suggest that the top number should be “less than 120.” With a second measurement, mine might have been lower or higher. I’ll be happy to get it measured every so often to make sure it’s still in a decent range, and not higher. But having someone – who is not my care provider, who does not even bother to ask relevant questions – tell me *three separate times* that my blood pressure is “right on the line?” There was no discussion of the bigger picture of my health, just a subtext of “you’re overweight, so let me be smug while looking for something else problematic I should be finding.”

That makes me think that somebody just doesn’t know what to do with somebody who is higher than normal weight yet not explicitly way hypertensive and ZOMG BOUT TO DIE! And it makes me question whether the folks doing the measurements have my actual health in mind or might be fat-phobic a-holes who need to find something, anything, to be judgey about if a person is not a BMI-chart-normal-weight. That’s not exactly a charitable reading, but I can’t properly convey to you the “looked at my weight on a card, and then thought they knew everything there was to know about me” exhibited in this brief interaction. In just a short minute, instead of forming a partnership in which my blood pressure could have been calmly monitored for more information, a hostile relationship was created in which I assume the measurer and her cohort are more interested in stereotypes than health.

Not much good for patient engagement, that.

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9 Comments leave one →
  1. vesta44 permalink
    May 31, 2011 11:31 pm

    I always thought that 120/70 was normal for blood pressure. Have they lowered the diagnostic standard for hypertension? It used to be anything at/above 130/80 was considered prehypertensive, and my doctor doesn’t say anything to me if my blood pressure is anywhere in the 120s/70s (I weigh 376 lbs and am 5′ 7″). My husband has type 2 diabetes and as long as his BP is in the 120s/70s range, his doctor is happy. So for this person to get all in your face about 120/70 seems a bit over the top to me. I think I would have gone off on her, if it had been me (but that’s just me, and I’ve been known to walk out on my doctor when she gets in my face about my weight and how I need to visit the Nightmare on ELMM Street again).

    • June 1, 2011 7:07 am

      Yes – not sure exactly when, but they now call 120-139 (top number) or 80-89 (bottom number) “prehypertension,” and <120/<80 "normal." I thought it was a bit over the top, too!

    • June 1, 2011 4:59 pm

      I was gonna ask this as well, because for much of my life I routinely had 117/70 and was always told that was on the low side of the normal range. So I’m puzzled at the idea that 120/70 could possibly be considered hypertensive. Even now, when I range from 120-124/70, no one says anything to me about it. Except when I complain about it not being 117 any more. Then they say, “what do you expect? You’re getting older.”

      So it sounds like you ran into someone who was both clueless and agenda-driven. What a shame.

  2. June 1, 2011 7:06 am

    Just tell them it’s ‘white coat hypertension’. That works for me. It’s measurably true in my case, but I never had any trouble with that until 2 or 3 encounters like the one you describe.

    Vesta, the standard these days is that 120/80 is ‘pre-hypertension’. I think 120/80 is considered ‘okay’ and 121/81 is high.

  3. onesillyme permalink
    June 2, 2011 12:32 am

    If BP taker is focused on weight, you can explain white-coat hypertension, just took real Sudafed, ate salt straight from the shaker on a dare, what have you. They will still be focused on your weight. And shame on you for not being ashamed of it!

    • June 2, 2011 8:40 am

      LOL. I know, I need to just live in a hole, a hole for fat people! Fat people who dare not to have 150/100 BP! ;)

    • June 2, 2011 3:07 pm

      And, frankly, even if your BP was 150/100, it would not help to be told that you were on the verge of dropping dead. Even if the provider believed that your weight caused it. First of all, because it’s not ethical to use scare tactics to change people’s behavior – that is NOT informed consent. Second of all, what are you going to do? Chop off a limb on the spot to improve your BMI?

      I think this might be an occasion to ask, “What do you tell thin people whose bp is 120/70?” … and then get thee to First, Do No Harm (http://fathealth.wordpress.com/), and from there to the Fat-Friendly Health Professionals List.

      Sheesh. Encounters like this make me wonder whether medical professionals really can’t find any other problems to solve, and have to keep falling back on the same-old, same-old.

      Btw, you can buy blood pressure monitors for $30-40 at any drugstore – I found this very helpful when I had to check it nightly to see if new medication was affecting my bp. I checked my monitor against the one in my doctor’s office, and it was accurate within one or two points.

  4. Ms. Crazy Pants permalink
    June 2, 2011 11:28 pm

    I would instantly lose confidence in the knowledge my provider has after that kind of announcement. That person is full of BS.

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