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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please negotiate a management plan with Helen.

Scenario

Helen Berkovic is a 53-year-old prison officer. You have just returned from leave and in your absence Helen has been seeing your locum. The locum has diagnosed essential hypertension as blood pressure readings have been over 180/110 on three different occasions.

The following information is on her summary sheet:

  • Past medical history

  • Nil

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Family history

  • Father—on blood pressure medication

  • Social history

  • Smokes 10 cigarettes per day.

INSTRUCTIONS FOR THE PATIENT, HELEN BERKOVIC

You are a 53-year-old prison officer. Your own GP has been on leave and you have been seeing the locum. The locum has diagnosed high blood pressure but you don’t know what this means or what can be done about it. Your dad has been taking medication for his blood pressure for years.

You have now come to see your own doctor to plan what to do.

The following information is on your summary sheet:

  • Past medical history

  • Nil

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Family history

  • Father—on blood pressure medication

  • Social history

  • Smokes 10 cigarettes per day.

The locum conducted a physical examination that was normal. Your BMI is 27 kg/m2 and urine dipstick was normal, with no evidence of micro/macro-albuminuria. The CXR, ECG, echocardiogram, FBC, UEC, LFTs, fasting blood glucose and fasting lipids were normal.

SUGGESTED APPROACH TO THE CASE

Management

Re-establish rapport

Confirm diagnosis of essential hypertension

Confirm with Helen that investigations and examination were normal

Explore Helen’s understanding of hypertension and treatment.

Treatment options

Non-pharmacological

  • — Exercise

  • — Weight loss

  • — Salt reduction

  • — Reduce alcohol intake

  • — Address potential life stressors—work

  • — Treatment of obstructive sleep apnoea

Discuss smoking and assess readiness to quit

Pharmacological

  • — Start medication.

Follow-up

Document BP and suggest mechanism for patient to record readings, for example, manually on a card or using an app on a smartphone or tablet

Add to recall system to recheck UEC and BP on treatment

Provide sources for further information for the patient.

Image not available. CASE COMMENTARY

This is a common general practice situation. The first aim of this case is to ensure that the doctor has the skill to take over management of a patient from a colleague.

Traditional medical training is for doctors to plan patient management after taking a history and conducting an examination themselves. The increase in team practice requires doctors to pick up ...

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