Hypotensive and Hypertensive?

So I was supposed to meet with my preceptor today to see patients, but he was in clinic for about 15 minutes so I went around with one of the residents. She's one of my favorites and has the best doctor-patient interaction skills I've ever seen.

In my 3.5 hours there we saw 6 patients. Two of them had the exact same name and were put in the exact same exam room, one right after the other. Weird. They couldn't have been more different though. One had never been on any medications and was 65. The other had more doctors, surgeries, and prescriptions than I could keep track of. She was nearly in shock when the doctor told her that a family medicine doctor could do more than just annual pelvic exams. "You mean, you can refill my prescriptions too?" Uh, yeah... Maybe not your morphine and hydrocodone, but we'll get to that later. I think when you're taking so many pain meds that you require daily phenergan or else you vomit all over the place it's time to reevaluate the situation. Whatever though. I don't know much. I'm just a student.

I got to hear 2 heart murmurs, though I really don't think I would have caught them if I hadn't known they were there. They were both very faint. I got to see otitis externa for the first time - that's just an infection of the ear canal and not an inner ear infection. Basically the canal looks red and inflamed with some flaky debris.

Probably the best part was when during a yearly check-up type thing for a new female adolescent patient the mom busts in during the doctor's history and starts asking questions about some online drug prescription plan thing that sounded kind of shady. Then the little girl busts in and says "Mom, this is MY time." Priceless. It was so true.

We also had an older patient who was STILL bitter about a breast lump from 5 years ago that wasn't picked up by radiology. She tried to tell us that calcifications in the breast tissue were a sign of cancer because they signified change. Umm no. You don't tell patients with calcification (a very normal thing that can happen in older women) to go out and get a double mastectomy. Whatever though. It's just kind of funny when the patient tries to tell you how to do your job. I'm not bitter though.

Oh yeah, I almost forgot the whole reason for the title. We had one patient who was hypertensive and obese (no diabetes Laura. She wasn't the trifecta :)) She was on no meds for hypertension. She had never been on any meds and was otherwise healthy. So the resident was going to start her on a drug for hypertension. Then she tells us sort of on the way out the door that she FAINTED last week. The way she described it was typical vasovagal syncope (fainting due to hypOtension). She got up from a seated position, walked to the bathroom, and woke up on the floor. This happens when blood pools in your veins when sitting or lying. You require the muscles of your legs working to pump the blood back up to the heart (and brain). Then she also mentioned some tingling sensations in her face and a feeling of something stuck in her throat. Seriously? Needless to say the doc decided not to go with the meds just yet and to get a further workup of the patient - EKG. The problem? No insurance. A simple in-clinic EKG is about $800 when you're self-pay. Some places don't care and just do all the tests, no matter how expensive or necessary. UMC tries to work with you and figure out what tests can be delayed, which are most important and the cheapest meds that are the most effective.

Anyway, that was just a typical day at the clinic. I kind of love family medicine so far, but I'm not sure that I won't fall in love with something else next year. I'll keep y'all updated.