Second Opinion

I had the best history last night:

“I felt a little odd, so I went to Walgreen’s and checked my blood pressure, and it was high.  I wanted a second opinion, so I went to Minyard’s.  It was high there, too”.


I like patients who get their own second opinions from competing drug store BP machines before coming to the ED.


  1. I suppose Tom Thumb would be the tertiary refferral center…

  2. Keep in mind you were just the third opinion.

  3. Atleast your patient was actually concerned about his BP. Some patients could give a you know what. I’m always worried that those machines won’t stop inflating and break my arm off. Or maybe it won’t deflate and I’ll be stuck in the machine, (overhead store speaker)”Medical emergency, isle 5 at the BP machine again,…. medical emergency isle 5 at the BP machine.” That would be a little embarrassing.

  4. Would this person have been considered ‘cautious’ or ‘competent’ if they had an at home machine to check it? I realize going the the ER for a high BP reading isn’t what should have happened, but I admire the person for at least having the gumption to find another machine and double check. I detect a bit of snobbery in the post. Of course, having to deal with BS day in and out in and ER tends to ‘chaffe’ ones hide beyond what normal folks deal with.

    Carry on. Love the blog.

  5. You must have snobbery and amusement mixed up.

    And, what home BP machines do for me is: keep me busy. The worried well bring in page after page of q15 minute BP measurements, “…and they’re all over 150..” and are astonished when I tell them that that’s not really an emergency (barring other symptoms, it’s a little more complicated than that). Anxiety can elevate the BP too, and if you’re so anxious you do the above my first concern is the anxiety, not the minimal hypertension.

    I refer all of them to their regular doctor and recommend three BP checks a day, max.

    (DWL: I know long term BP control is important, and I’m glad people are interested in their health. Unfortunately, ED”s aren’t either the place for long term adjustments of anti hypertensives).

  6. He might have come over to where I work to get a third/forth/sixteen opinion. We had two blood pressure checks within an hour. One of which was also using his local grocery store and it was around 150ish.
    He then started checking it every thirty minutes and gave an extremely long story about it. I’m surprised the doctor I was with let him ramble on and on. Maybe he just wanted to sit down for a moment.

  7. Goatwhacker says:

    Just like I wondered why patients think all little red spots are spider bites, I have to wonder why patients link any possible symptom to possible high blood pressure (I think I am gradually becoming a medical Andy Rooney with all my wondering). True hypertensive emergencies are rare, but it seems like the first thing people do when they don’t feel right is check their blood pressure.

    I think home blood pressure cuffs are great. I’d much rather adjust someone’s meds based on a number of readings instead of just the one in my office. I always tell patients to take a relaxed attitude and there is no need to go overboard.

  8. For every overly anxious person checking their pressure too much, there’s probably a hundred who check it once, it’s OK, so they don’t think they need to ever have it checked again.

  9. And they don’t come to the ED.

  10. I love it when the nurses hook them up to a continuous moniter that takes the BP every 15 minutes and patients get concerned that the blood pressure is “jumping all around” from say 120/70 to 135/75

  11. I am a former retail pharmacy manager at a nameless megacorp– now offering $4 rx’s without increasing staff to even further their practice of prostitution of pharmacy as a profession and putting the community pharmacist out of business around the nation. Guess Who?
    Currently I am attempting transitioning to hospital pharmacy and can absolutely relate to this sort of scenario. We actually had patients/customers who took pressures via the machine constantly throughout their entire 2 hr rx wait! Pushed the red button over and over, therefore not allowing a reset-then complaining that it didn’t work right. (Of course it is the pharmacy manager who has to try to “fix” the broken machine as the wait grows longer!)
    Another favorite is the “compliant” type 2 who browsed the markdown birthday cake display and frequently sampled in the rx waiting area while we filled her diabetic meds. Paid by state medicaid, naturally.
    Of course that’s another topic for another day. Cool site! Thanks

  12. Thanks for coming, Kim!