Bad Blood Pressure Measurement Is Killing Our Patients
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- Опубликовано: 19 июн 2019
- Our secret shame: we suck at checking blood pressure right. Here's how to fix that and save lives.
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Thank you!!! More often than not whoever is taking my blood pressure (physician, nurse, medical assistant) decides to hold a conversation with me while taking my blood pressure. Last time I went to the doctor, the MA held my arm so it was a bit higher than my shoulder. She commented that my blood pressure was on the low side and I replied that she was holding my arm above my heart. Her response, “I am tall and so the arm ends up being above the heart.” I told her I was getting much higher readings at home and I kept my arm heart level. She agreed to take my blood pressure again with my arm at heart level. This reading was high, similar to what I was getting at home. To make matters worse, I was seeing a physician who specialized in blood pressure and the MA was part of this office. The physician I see from this office relies on the MA and does not personally check blood pressure. I am finding that improper blood measurement technique is now the norm and it does not matter who is measuring the blood pressure.
So true. At my medical office they make every single mistake that was listed in this video.
@@peggymaresh Tell the person to stop and position yourself properly and then have the nurse or MA take it. Back in the day when I was still working I found myself at times pointing to the glove box before a doctor would touch a patient and at other times pointing to the hand sanatizer dispenser as they were exiting a patient room.
I think they do it on purpose
One time while my blood pressure was being taken, I thought I would look at my mail. Found a letter from my lawyer. Highest reading I’ve ever gotten, by about 40 points.
Retired nurse here. Dr prescribed hubby an ARB for HTN. He filled the script and I told him don’t you dare take any until we do a journal diary of his BP over time. This morning’s BP after exercise, supine was 102/66. He’s a retired airline pilot and flies his little plane now. Thanks for your PSA. I did recommend he focus on lifestyle changes - diet exercise and stress management.
The sort of things recommended by their oaths names sake, Hippocrates. But then those people also labour under mystery babylon symbol the caduceus, whose associations make it seem obvious they would do these things to people..
Supine blood pressures are normally lower than sitting/standing. They do not reflect the pressures that a person will experience during the course of the day, and these daytime pressures are the ones that should determine treatment.
caprafan thank you. I do understand that. The point I was trying to make is that he needs to journal his bp before taking the med knowing how he has white coat syndrome. Lifestyle changes have no adverse side effects.
YES!!! I have never found one doctor’s office that does it correctly. I am a nurse and this drives me insane!!!
Lucky You!!
Treat the stress! The blood pressure comes down! Counsel your patients. We do this with SOLDIERS all the time. My eyes were OPENED: we check it 6-10 times over 3-5 days and we rarely have to start meds. Stress is the reason, dropping it is the cure.
I am over weight, and my bp is borderline high. The professionals who check my bp never never never check it correctly. My arm is too big for the standard cuff, they check it with me hanging off the edge of the exam table, just after I have ran a marathon through some maze of a medical office. I really appreciate this video. I will never agree to bp meds when they cannot do their job correctly.
We need more citizens like you to speak up and just say NO to substandard medical “care”.🙏👏🏼👍🏽🖖
That's a fine stance to take as long as you take your own bp and realize whether you really have hbp or not. It's your health not theirs so you need to be informed and not rely on some nurse who probably works for some medical group that treats them horribly.
@@ODK321 substandard care in any form is not okay.
@@1timbarrett no kidding. But that wasn't the point of his or her comment.
Make sure you be upfront with your doctor as to why you're not taking it. You may not need it, but you also may in fact have high blood pressure and not be getting treatment.
At my clinic they always take weight first in hallway. Then put you in room and immediately take BP.
The anxiety of having being weighed for many is real.
And if weight you hear is higher than expected, BP often goes up more yet.
I'm so thankful for doctors like this
Absolutely correct everything you said. Truthfully I think they do it on purpose to try to get your BP high enough so they can prescribe meds ...I have white coat syndrome because my job has a limit on what employees' BP can be + I usually border close to it, if I'm over the mark I'm laid off so I've learned the correct methods. I have been to dozens of clinics over the years probably totaling 50 times + EVERY SINGLE TIME someone would try to measure me wrong. It's so frustrating, sometimes I try to correct them only to get rebuttals + replies like 'Oh it's ok to measure your arm with clothing, or it's ok to talk, that's a myth, etc Sometimes I'ld refuse when told to hop up on a table where there's no back support + my feet would be dangling. Some never even supported my arm at heart level, some would ask constant questions while taking my BP.. Not one of them would give me a few minutes to relax after walking through the halls of a clinic + taking weight measurements etc. Others quoted my measurement but only if I asked for it. Also sad are these people who don't know a persons BP goes up as you age, so what is normal for a senior is not the same as a teenager...= ask the geriatric society
This is incredible. I’m a nurse. Blood pressure needs to be done correctly or we shouldn’t be doing it. Thank you.
Geez! Finally someone said it. I’m a doctor from Brazil living and working in the US since 2014 and NO ONE in the US has ever measured my BP correctly when I go to my physical.
You forgot the step where we sing them soft kitty
😆
I have literally never had my blood pressure checked the way ZDogg is stating.
That's what I was just thinking!
Me, too. Feet on the floor? Nope. Back supported by a chair? Nope.
I've had a few of the things he said but never my arm at heart level until a couple of weeks ago. And then a lot of the other things weren't followed...
That's really the gold standard way to do it. Anything else is to get it done and check boxes.
Sitting on high up table, legs swinging in the breeze, slouched over from no backrest and usually the cuff cuts off circulation so much it hurts...oh plus the white coat!! I'm doomed to fail....
Oh my gosh thank you! As a nurse and as a patient, I bring this up regularly! I get so frustrated when I’m run back and cuff is slapped on and they want to tell me my BP is elevated, I explained this to my MD when she came in and asked for it to be retaken, she refused and instead wanted to treat a slightly elevated pressure! Needless to say I got a new PCP and it’s a miracle, properly taken B/P, never elevated. Med pushing docs piss me off to no end, and tech’s and nurses that don’t take a proper B/P. It’s the basics people!
Latest racket by Big Pharma is to recommend lower target levels for blood pressure so that more people are put on medication. Hey, it worked with the cholesterol con and statins, it will work here too!
I've complained about how those moron nurses take my blood pressure on a number of occasions. And the dumbfuck doctor refused to even take B/P reading. He don't even know where the brachial artery is.
Bob Marshall That's exactly what happened to my husband. No wonder we no longer trust the medical community!
No medical professional has ever taken my blood pressure in accordance with the standard guidelines. For years I’ve sat on a stool or on the side of an examination bed; in fact, I cannot remember ever sitting in a chair. I can’t remember the last time my shirt was moved out of the way or my feet were on the floor or the cuff was even in the right place on my arm.
LOVE that you discussed this...an absolute pet peeve for me! It is concerning that many people are labeled as hypertensive when they likely aren’t.
True stories.
I.
“Why is your blood pressure so high?”
“I just ran up the stairs. I told you that I ran up the stairs instead of waiting for the elevator because I was late.”
**************************
II.
“Your blood pressure is high.”
“I’m here because I’m on the second day of a migraine. Pain and all that.”
******************************
III.
“Wow, your blood pressure is 170/80!”
“I told you that I have a dental phobia. This is a dental office. I have a dental abscess, I’m in discomfort, and I’m going to have a root canal today. Just ONE of those will increase bp.”
********************************
IV.
“Your blood pressure is increased.”
“You has me answering questions during the measurement. Please retake it.”
*************
I’m a medical professional and get this nonsense. I am tempted to start correcting offices on how they do blood pressure measurements because I’m finding these conversations disturbing.
Yes. Your BP is 178/102... That's why I'm here on my lunch hour. I'll try to squeeze the next appt in before work or leave early one day. L.O.L.
I have actually had to reteach the art of taking bp...as an older adult who lost 5" in thoracic height due to vertebra compression fractures from osteoporosis I have to have mine taken standing. Why? Well if you lost that many inches and your floating ribs sit inside your pelvic rims all of the organs are squashed when sitting, you'll get a high reading...my normal at home is 125 to130 over 57 to 80 but yet when taken at a facility it will range from 190 over 80 to as high as 200 over 90...it makes me angry when bp is rushed and taken incorrectly or the 'professional' doesn't listen to their patient...I've actually started to demand a manual pressure and if not done correctly ask to be done again...I'm a retired nurse and was taught how to correctly measure bp...I don't let ANYONE tell me my bp is high because I know better...smh and laughing at these incompetent 'professionals'...
White coat syndrome is real. Thanks for mentioning it
I can look super calm but actually in full fight or flight wound up tight enough to go ballistic!
My mother has had hospital admissions and 24 hr tapes, even after telling her Drs about her white coat syndrome. Now has a sphyg at home to prove she's fine 😏
Yes I have it
Hubby has it because of having some really rude threats from past drs, so at the Cardiologist he can have a 15 to 20 point difference between home and the dr office.
So is pretty nurse syndrome, especially after she just had you take off your shirt and ripped off the EKG stickers giving me a wax hair removal job.
Yes! Thank you! My Primary needs to hear this. Every time I go there my blood pressure is high. It's because their blood pressure cuff hurts me so bad. I have Ehlers Danlos Hypermobility and I am super sensitive. I was there 2 days ago and I still have red marks from the cuff. So my blood pressure was 159/96. Usually, he will talk to me about my "high BP" and how I should be on medicine. Meanwhile, everywhere else I go my BP is usually 128/70. If I wasn't such an advocate for myself, I'd be on BP medication when I didn't need to be. Many doctors today just don't listen. I have so many horror stories.
Same here. You really need to advocate with the EDS. If you have to be the jerk. Print out off the web what are the major/minor symptoms, and point out what happens when... I did this a couple of times, and they stopped rushing. I think they don't realize that quiet a few medical conditions make you present like you have elevated BP. I'm constantly correcting the staff. The Medical establishment doesn't think outside the box for exotic disorders until after you've wasted thousands. When it's obvious to everyone who reads health magazines or special interest stories. Then they wonder why we run off and quack ourselves.
Keep strong friend.💪
I would love to find out how to take my blood pressure so that it doesn't hurt so much. I've been taking it at home, and if the mmHg goes up above 160, it starts becoming painful. Sometimes it goes up to 190 or even over 200, and is very painful. Other times, it stops at between 170-180 and is more bearable. Usually, the higher the mmHg goes before it releases, the higher the reading. Manual readings are usually less painful and lower. If you've any info on this, I would love to know. I think most nurses think I'm exaggerating about the pain.
@@terryg4415 drop my BMI from 29 to 24. Glucose medication cut down by more than half and high blood medication cut by 1/3. BP closer to 120/80. Trying to get BMI to 23. 😂😂😂. Dropping BMI should be your priority.
Your experience is more common than you know.
I have Fibromyalgia and have "Allodynia" (many people with Fibromyalgia also experience alloddynia) which is similar to what you are describing as "pain due to a stimulus that does not normally provoke pain." I have a problem whenever I have gone to the ER, a nurse slaps on an automatic BP monitor, even though I tell them that it causes me so much pain. Once I pulled the cuff off before the machine was finished, only to have the nurse put it back on and hold it on my arm. My blood pressure ended up being ridiculously high (around 190/100) from being in so much pain!
Thank you! I always had low blood pressure until I started going to my most recent doctor (I'm no longer going there) because 1) Everyone there was really rude to me, 2) White Coat syndrome, 3) The nurse and/or doctor always made me answer questions, without skipping a beat, during my reading, including condescending remarks and pointed questions. My blood pressure was very high and they didn't believe me when I said it had never been that high. I was too reserved and fuming to say anything. There was just so much to say at that office. Grrrr. Had I said anything, do you think they would have been nicer and stopped asking me questions during the reading? No. They were condescending to begin with, and I was just "clueless." I wish I had someone like you as my doctor, ZDogg! Keep on keeping on!
Thank you!!! I teach nursing school and this is one of the first activities we do in lab. The students come in having completed their training as nursing assistants. It's my job to take them from data collectors to critical thinkers. I have them take vital signs using different routes and equipment and we compare results, techniques, etc. to see what improves accuracy. We talk about how important the accuracy of their assessments will be as nurses and how treatment decisions are effected by the data they collect and report. Thanks for this!
Thank you for teaching this way! I'm a nurse 30+ years. I can't believe some of the things I see being done by staff these days.
Usually when my blood pressure is checked, it is immediately upon entering the room, back unsupported, all the while the technician is trying to make pleasant chit chat or ask me questions which increases my anxiety. Usually by then, my BP is sky high. I always ask them to recheck it a few minutes later, and it is then normal. Another great mistake is checking BP at the ankle when the patient is sitting, feet to floor. This should be checked with the patient laying and ankles at heart level.
I'm quite short, so I can't have my feet flat and my back supported at the same time in the chairs at the doctor's office. I also have social anxiety, so any amount of time waiting to relax isn't going to help because I'm still anticipating the entire encounter. Makes me wonder if I've ever gotten an accurate reading before.
OMG THANK YOU! As someone who is straddling the line of good to pre-hypertension (admittedly I'm not healthy) it infuriates me when I go to the docs and they say "OMG your BP is 145/100!", when it consistently sits in the 118-138/78-89 range (varies a lot based on how stressful the job is that day). Doc tried to put me on blood pressure meds (low dose water pills) that made me feel like absolute crap; I nearly passed out when I jumped up quickly from under a car after 1 week on the meds (I was more than sufficiently hydrating due to the heat and to make up for the extra urination from the meds). Needless to say I stopped taking that crap
Just this Monday before getting fun fun neck injections they slapped the wrist blood pressure device quite literally as I was sitting down. The doctor remarked that my bp was high and I told them to give me a chance to sit down for a minute before you do that... glad to see I wasn’t wrong !!
Well, I have a problem because my feet are NEVER flat on the floor....I'm 4'11"and no one provides a foot rest/booster. Also, I would call mine 'black cuff hypertension', because it is the pumping up of the cuff that keys my anxiety. Most especially on the machine! Because they often do the cuff up snug to start with, and then the machine over-pumps it so that it actually pinches my skin and hurts my muscle. After a few painful experiences of being put on the machine and the nurse walking away, I put my foot down: I allow the machine to take one measurement and if it hurts, I remove the cuff. And when they complain or give me a dirty look, I tell them exactly why I did it. My regular doctor's office learns to do manual checks after that. I did have high blood pressure two years ago when I was diagnosed with diabetes. I went low carb and got both my blood sugar and blood pressure back to normal. Don't get suckered into meds off the hop, try low carb first. I'm am not totally against meds, but considering the possible side effects, and that people usually never get off of them, it is important to do whatever else you can first. Thank you for an instructive video...I hope medical personnel will listen.
THANK YOU THANK YOU!!!! Nothing is more irritating than having my blood pressure taken and them using a large or extra large cuff on me at 120lbs!! And when I mention it the nurse or aide talk down to me & tell me it will be accurate! I am an ICU nurse, I am well aware it won't be. Uggh
Bro !!! haven’t seen you in years since you were exposed the grunge for what it is. I’m glad to see you back.
I’m a RN in a pediatric nephrology clinic. Thank you for this. These are the ‘rules’ we instruct our families on when teaching how to take BP at home. We also advise to wait at least 30 minutes after exercise and avoid caffeine and alcohol.
You might also teach the techs never to tell a patient that if their BP continues to read this high they will have to go on blood pressure meds. That guarantees white coat syndrome because so much is riding on that next reading. I've been on meds for over 20 years because of this. Had a doctor refuse to treat me unless I complied. I'm one of those lucky people whose diastolic goes up under stress along with the systolic.
Yes!
ZDogg, you are full of the truth bombs we all need to know and remember!
Looks like I have NEVER had my BP taken properly in all my 75 years on the earth. It's either always over clothes, as soon as I am put in the exam room on the backless exam table with my legs hanging or after sitting in the waiting room for eternity, getting more and more anxious 😟.
Every time I get my blood pressure at doctor office I have to tell the nurse the same things because they always do it wrong. This is a great video!❤
Thank you! I went for a check and had lots of time waiting to meditate. The first thing the PA did was tell me to move to the bed. I said, can you take it here in the chair? I was relaxed. So, she pushed til I moved where, now my legs are hanging, my back is unsupported and I had no support on the arm which is now hanging toward my leg. Did I mention I have anxiety.🙉
Wow a doctor who understands it’s not about treating patients but it’s about treating patients correctly
That 5 minute “waiting period” just gives my blood pressure that much longer to skyrocket - I am the poster girl for white coat syndrome.
Me too! Always elevated at those places due to the anticipation of it being high.
Pls do you take bo meds?
@@fatimaumar5587 yes I take losartan right now but even if I double up before going to the dr. My bp will be sky high.
@@pegoneil thank you for the response. I never had high BP at home but only in at the hospital. But doctors don't want to believe me. Today my BP was 99/66 in the morning and 89/62 in the evening without medication. For the past three years I have been monitoring my BP at home and it has been awesome except if I has panic attack it will be a bit high but with three to four readings it will bounce back to normal. I tried to take bo meds when I am going to hospital but it doesn't solve my problem. I even took my BP monitor to them but they don't seem to agree. I will do what just works for me. I exercise and eat healthy with a good BMI
THANK YOU. THANK YOU. an ade took mine twice and said it was in the 200s. I ask both time for the correct size blood pressure cuff. She said, oh that doesn't matter. I told the dr. and ask to have the correct cuff. It was then 153/85. I'm 78.
I was checking in for knee surgery. I walked about 200 feet, they immediately put an automatic BP machine one me. It pumped up and got an error reading 7 times in a row. At the same time a woman was asking me questions and filling out the paperwork, AND a nurse was taking blood out of my other arm. ALL AT THE SAME TIME!!
Yes, it is measured incorrectly all the time! As a really sick patient I experience this on almost a weekly basis.
Thank you for sharing this very important information Doctor!!! Much needed these days! 👍❤️🤗
I have been treated for high blood pressure for more than 10 years. I measure my blood pressure daily and have determined almost all of your recommendations on my own. Doctors do not tell you these things and their medical techs and nurses do not practice them. They almost always do it wrong so I ignore their results. If they comment on the high reading they took, I tell them what they did wrong and make them correct and repeat it, always resulting in an completely normal rest reading. Makes you wonder what else they are doing wrong.
They do injections wrong. Protocol says to apply alcohol to wet skin for 20 sec and air dry. Remember its the same rule for hand sanitizer.
Some don't even know how to use the scale. The last time I was weighed at dr office, the aid or whatever she was put the setting at 150 & then fiddled with top & told me I weighed 153. I told her I weigh under 150...she argues the scale is accurate because it was just recently calibrated. What a joke our healthcare system is.
Thank you for this!! Every medical professional needs to see this! I've been a nurse 30+ years. I can't tell you how many times I've witnessed so many ways this is done incorrectly. Personally, I refused to be put on HCTZ for "high blood pressure". Dr. Z, please make a video showing the proper way to take one manually, how to listen and what to listen for. Taking manual BP's is becoming a lost art.
Yes, thank you for this. If I hadn't known this, they would have kept me in the hospital after giving birth for who knows how long. They kept asking me questions or checking other things while doing my BP check and it was super high until 1 night nurse noticed the errors, and taught me so that I could be my own advocate.
Bless that nurse.🙏😘👍🏽💕
Once I was late to a physical, and I ran about 2 miles to the Dr's office. I was shown to a waiting room almost right away, and they took my blood pressure, less than 10 minutes after the run. They took my blood pressure and it was very high. Later on the doctor said my blood pressure was high, and we'll want to monitor it to see if I need blood pressure medication. I mentioned the running thing and the doctor gave me a look of skepticism. Next year I was back for a physical, without running, and my blood pressure was totally normal. Doctor told me, "looks like through dieting and exercise you've controlled your high blood pressure, good job"
My doctor is obese and discusses my weight and meds with me 🤷🏼♂️.
I hope you fired that doctor...
All true. I complained that my clinic had a radio blasting loud music of an aggressive tone in the waiting room. BP was 210/105 by the time I was in the chair. (I do suffer anxiety) so staff had to be updated on this to provide a calmer waiting room. Now a TV shows videos of general health advice with a soft tone. Big improvement.
yeah if you had a CORRECT read at that level you'd be DEAD!
Yes, I regularly have my BP taken after several minutes sitting in a waiting room dominated by a TV showing BBC News. My BP would probably be lower after watching The Exorcist.
My OBGYN’s office is the only office that has ever taken my blood pressure like this.
I’m so used to crossing my legs when I sit - The medical staff would always have to remind me kindly “Legs uncrossed and feet flat on the floor, sweetie.”
If a nurse or doctor called me sweetie, that alone would raise my bp
Funny, I would rather appreciate being addressed with the term of endearment (if sincere) rather than a brittle command from a soulless robot. I guess it depends on how you prefer to be addressed .. as a human being or as a hysterical chihuahua.
Exactly what I was taught in nursing school... In 1974.
Too bad most of the medical community missed that class!!!
I can not tell you how many decades I have gone through this! I take it at home with 2 different blood pressure cups and it is normal, I walk into an office or get put under for my endoscope and bam! it is up! They take it over my clothes or pretty much every way except what you said. I have really small arms and the cup never fits!
Tried telling a tech that their cuff was too small and she didn't care.
Jennifer Rey yeah bc you know they’re so hard to change lol!
stand your ground. "your not doing it right I want to speak to your supervisor"
I get bruises.
Art Jury
Supervisor ?? 1
I’ve done exactly the same thing. They look at you like you have two heads.
Great topic to mention. Both my mother and father have blood pressure issues, one high the other low and the difference it makes to check their blood pressure at home, when they're comfortable, at heart level and with back support is considerable when compared to BP readings from a doc's office, right after walking around, not supported, and not at heart level.
I’ve only just found this! I felt the same as you re arm levels not being correct etc. I have just left a comment advising people to buy a monitor for birthday/Xmas presents for loved ones. I hope you and your family are keeping well.
It takes more time to do it correctly. These days, the docs are double booked. Please dont get on the MA's if the clinic schedule gets behind. It takes time to do it correctly.
Agreed but...
It’s not worth a wrong reading that puts the patient at risk.
Then they should know it's an inaccurate reading and not try to diagnose based on a false number.
Then don't bother doing it. Bad data is worse than no data at all.
Thank you! My GP waits until we've discussed everything before taking my blood pressure. He has me sit down in a chair, both feet on the floor. Then, to show how you can get a vastly different reading, he had me get back on the exam table with my legs dangling. My pressure with that reading was much higher - he said it would have otherwise suggested adding another blood pressure meds (I take a calcium channel blocker for migraine prevention). Your video must be seen by nurses, NPs, PAs and doctors.
I have had my blood pressure checked more times than I care to remember. I don't think I've ever had any medical professional do it the way Z Dogg talked about in this video.
Wait 5 minutes? Never
Feet flat on the floor? No.
Back supported? No.
Arm supported at heart level? No way?
Add in a couple of times when I'm pretty sure they used the wrong sized cuff and the fact that staff are always talking to me while measuring my BP and I'm actually a little worried now.
And the room is always cold.
Why has the acceptable bp level changed so much. My dad who was born 1923, and several other friends in their 70s like me, said they used to say 100 plus your age. No matter how they keep lowering the acceptable level, people mostly eventually die when their heart stops so heart failure.
The acceptable blood pressure level is driven by big pharma. The people who make the drugs want you to take the drugs so the recommended levels keep going down to ensure people are diagnosed to need the drugs. The American Academy of Family Physicians say 140/90 is fine. The American Heart Association (who take huge donations from big pharma) says 120/80 was fine. Now they're starting to say 120/80 is too high so doctors prescribe more drugs.
@@AllynHin when they lowered the level in the US from what it was in 2014 to the new 120/80 it apparently meant about an extra 46% of the US population could need to be medicated if they got persuaded by their doctor. What a bonus for big Pharma!
Wow- this is eye opening. I went to the urologist this week and they took my BP over my sleeve while they talked to me without a 5 minute wait.
I feel blessed to know this. Mine was 140/78
When I was a Navy Hospital Corpsman back in the 90's I worked in a Naval hospital (oncology ward) and then later on a ship and took many vital signs. And i saw many vitals being taken by others. And one thing I realized very quickly: almost no routine vitals have an accurate BP reading. Very few caregivers take the time to do it correctly. Machines might have slightly improved this, actually. But still this is done way too casually as a general rule.
Thanks, Z-doggMD. Correct room temperature and emptying the bladder aren't always practical in all settings but BP prescriptions are also not often given in those settings either (eg. ED). Also, a few mmHg doesn't seem that statistically significant (unless the BP significantly out of normal range). ...great tips on the cuff and uncrossing the legs. I'm often asking patients to uncross legs. I would add: watch the arm movement and make sure they are relaxing it and not moving the arm around. Thanks for the Vlog!
According to your guidelines, not a single healthcare provider in my entire life has come even remotely close to measuring my blood pressure properly. It’s appalling really.
As a larger person I cannot count the number of times I've been told I have high blood pressure by people using a blood pressure sleeved it looks like it was designed for a child the pressure will always come out incredibly too high and then if they put you on medication for it next thing you know you're in the hospital because you blood pressure crashes these people are insane nobody wants to do it right thank you for making this video
Nursing student here, -graduating soon!
It’s always great to get a little refresher on core skills
Unfortunately, I've had to see way too many doctors in my 47 years. It wasn't until I found my current doctor (about 5 years ago) that I realized my BP was consistently being taken wrong. It's good to know that there's a new generation of medical professionals learning to do it the right way!
BP at home: 115/75. BP at doctor’s office: 160/80. The nurse asked me if I was anxious. “Look at how high my heart rate is!” I said. “It’s only 98! That’s normal,” she replied. I explained that my normal resting HR is upper 50’s/low 60’s. She raised an eyebrow and said that a heart rate that low would only be normal in a very physically fit person. I told her I AM a very physically fit person. She raised the eyebrow again, presumably because my BMI is 26-point-something. Anyway, this is why I hate going to the doctor!
The biggest problem is prescribing medication after only one or two BP readings. I told my doctor "No" on the meds until I had tracked my BP for a period of time and then showed him the results.
You'll need to give me a child-sized chair if you want my feet flat on the floor.
Great idea there, actually! There SHOULD be a Goldilocks chair in every examination room.👍🏽👏🏼🙏
@@1timbarrett , or they could give me a footstool to put my feet on.
@@kimberlycooper4170, don't let anyone tell you that you are short. Tell them you're "Fun Size." 😁
@@jsusna1972 , fun size! Lol! I like your response!
This video really needs to be shared with hospitals (in room measurement and ER). I've been the one with the cuff on and I've seen and experienced the things you said should not happen. Most of the time ... at least 80% plus, my arm has NEVER been as you say it should ... my arm usually resting on the bed (I'm sitting up) . I'm going to my Cardio Dr. in a few days and I'm going to pay close attention!! Thank you for this video!!! My daughter is a cardiac nurse ... guess who will be tested!!
Follow-up: Went to see my cardiologist today... had blood pressure checked (as always) and I never said a word ... his team passed with flying colors!! My daughter also passed her "test". I'm proud of her ...she graduated from one of the best nursing schools in our area. Ya, proud Mom here!!
I hope people watch this important video!!!
true. coming from driving walking in from a hot day my BP was 140/90. 5 min later sitting in an aircon room 120/80.
Thank you, thank you, thank you!!!! As both a registered nurse as well as an end stage renal patient on hemodialysis (autoimmune), accuracy in blood pressure readings have always been very important to me for all the reasons you state. And I want to add too, if someone is going into a medical setting, it is your right as the patient to ask the provider to not take your blood pressure right away. In the clinics I've gone to (aside from dialysis), most of the nurses now will finish doing the intake questions and let the patient sit in some cases even longer than five minutes; many need anywhere from fifteen, twenty, or more to get an accurate reading. You may even need it taken at the end of the appointment as well, which they should be willing to do if you ask, especially if they are trying to get an accurate measurement for treating hypertension.
Love that you say stop talking! Yes!!! I'm not even a nurse (but I was my dad & mom's caretaker and learned a lot from some great med professionals). It always drove me crazy when they'd say it was high, when they checked it moments after I walked into the rm, were talking to me the whole time, and put it over my shirt, even if I tried to move it out of the way. But you're right everyone is in such a rush they neglect how much all you mentioned affects the numbers.
OMG, I am a nurse and this drives me crazy!! He is totally right! Also, in clinics and most doctor offices the machines and monomiters are rarely calibrated, which also effects the readings. And the instructions on the home bp cuffs say to take 3 readings a few minutes apart, and average them, which most people do not do. Plus if the batteries are low in the home machine or a battery operated one in an office, the reading will be off as well. At an office visit, I once had to insist my pressure be retaken with new batteries......I could hear that the machine was slowly inflating the cuff and new the batteries needed changing. Watch out for that. Home cuffs are not as accurate as using stethoscopes and manual cuffs, but that is a skill that has to be taught. So, the main issue is that education in bp taking is not actually being taught correctly anymore. The theory behind why you do certain things is being lost. And relying on machines is the norm.
Yes, this! Im an RN and I got "elevated blood pressure" when they took my BP after taking plain films and manipulating my bad shoulder.
I’m an EMT and we never have ideal circumstances for blood pressures
SAME! I work in a super busy office, barely enough time taking ONE BP reading before a doctor busts in on me. Always getting in trouble for talking to patients and trying to calm them down before vitals.
Agreed, but we are looking for extreme anomalies, right? Signs of decompensation rather than diagnosing someone with hypertension and putting them on meds.
We know that’s the point Sarah , the intellect is lost in training but rather a business aspect far surpassed the good health aspects of evolving medicine goes along the lines of the human as well , doctors practice medicine, define medicine and you get no cure but more of a doctor that treats the symptom , which medicine is a camouflaged mechanism and isn’t a cure , the body is of natural biologics and medicine is not so it’s just a brain trick to relieve you if your symptoms but the problems are still there eating you up a bit at a time , they don’t practice the heal because that’s not medicine but rather herbal which is the only way the body can heal itself by replenishing itself of what its losing and that can’t be chemical medicine , because the body is made from earth it has to come from the earth to heal you period , now I wouldn’t tell you not to use medicine it’s very helpful because it’s a quicker way of relief and use in conjunction with natural products that may takes months to begin its repair , the medicine will keep you going proficient until the body begins the natural heal from the earthly herbals that God provides for us is key as many health care systems outside the US practice medicine as an emergency only while administering natural remedies as long term care rather in the US they want you on medicine long term and will tell you nothing of use of herbal treatments which is a walk of death from the plank
I think he is talking more offices.😊
At past dr. and dentist visits I have exhibited borderline hypertension. It says on my chart "white coat hypertension." At my most recent dr. appointment in March, I actually protested that my BP would be checked for the second time in three months because I didn't want to deal with the hassle. But the nurse brought in a pillow and put it under my elbow. I had never seen this before and asked about it, and she told me the arm has to be at the level of the heart. When the cuff was about to start deflating, she told me to think happy thoughts and then was quiet.
My BP was 120/79. I never want to hear about white coat hypertension ever again.
Thank you. I was told to start (whatever it was) due to high blood pressure but I was so freaked out by how much the cuff hurts I knew for sure it was elevated due to stress.
I've had to do a week's worth of blood pressure readings at home .. after the nurse found my blood pressure to go up from 151/90 and after rest to 159/92 so a week's worth of home readings showed that my blood pressure systolic was 145 at its lowest to 201 at its highest throughout the week .so yes ..my blood pressure certainly is high .
And everything you said here is perfect .as this is exactly how I self tested by being at my dining room table back straight against the chair and arm in line with my heart and supported...also much calmness around me ..with the cuff comfortable not too loose and not too tight
Still ...it's now time to work in getting my results lower don't you think? Ha ha
I have venous and arterial PVD and Angina so yup I'm not in great condition ..still I'm determined to get better by going out on many leisurely walks .. to ease my symptoms .
Long as I don't come across too many steps on these walks I should be ok to aim to do little and often this form of exercise 😂. ❤
YESSSS! As an RN I can say this is ALL TRUE. After a bed bath, it's the first thing they teach you.
Thank you!
Yes!! Im a night shift nurse. When my CNA comes to me with a high BP that's out of the norm for that patient, I always go and take the cuff off, make sure its the right size, position it properly. Tell the patient to lie still, relax l and NOT TALK. I look at the machine and dont talk either. Amazingly many times it is normal!! Yes, def a pet peeve for me.
I've had lots of nurses measure my pulse wrong and just write down some BS number. With BP, I ALWAYS offer to take my cardigan off and they ALWAYS say, "No, that's alright.' Like, why?
Thanks for the advice Doctor, too bad most Dr. Offices don’t follow this. Almost every Dr office I’ve been to have you sit in a waiting room with TV blasting loud, constantly called up to reception desk asking about insurance info and updates on personal info then rush you to exam room and slap the BP cuff over your shirt and talk to you as you have to jump on the exam table…
I love this guy! this is a good man! Thank you so much for this video Zdog MD!
Awesome video.
I'm a dentist, and I check blood pressure for everyone who sits in the dental chair. I don't care if they're there for a checkup, or a surgical extraction.
One thing I noticed with white coat hypertension is that it's almost always accompanied by an elevated pulse (100 bpm or more).
It's when I find a patient's pulse is in the lower 60's with a BP of (say) 155/100 that I suspect uncontrolled hypertension. Most of the time I find patients with numbers like that to be noncompliant with the medications prescribed by their PCP.
Anyway, I love the advice you presented here. My dad was an MD and he was the one who taught me how to measure BP and really emphasized measuring HR as well.
NineBreaker in my state that is the law. But, the dental office is not a good place for a bp reading, maybe it could tell you if the trend is rising or falling, but otherwise, taking a bp in the dental chair is a useless act.
Glad that you are checking bp but a person in a dental chair with typical dental lighting is going to read high.
I went to the ER after having my car totaled by a drunk driver. The nurse who took my BP kept talking and asking me questions. I told her I wanted to have a few minutes to be quiet and she was disgusted and said, “It doesn’t make that much difference.” Then she was surprised when my BP was 185/90. Duh. I just had my car totaled, plus you’re asking me all these questions! I take my blood pressure twice a day at home (morning and night) and keep a record of my readings in a notebook and take it to all my doctor appointments.
The only problem I have with your explanation, as a retired hospital CNA with 16 years experience, is that it will undoubtedly negatively affect executive compensation in our large healthcare corporations. Therefore, it is a non-starter. But good job explaining how it "should" be done.
Very timely. Have just been having a discussion re: BP with my Family Doctor ( I am doubly lucky - #1) I'm CDN #2) my GP is Outstanding). I was registering as highest end of normal at her office. Went home and took my BP with an automated cuff every day for two weeks before a return visit. Numbers were fine - only one reading was high normal, all the way down to 117/78. Buy a good quality home unit and take your own BP, following Zdogmd's guidelines here. Great advice.
In clinical research, I teach my clinical team these very steps to obtain accurate reading. Great video
Couldn't agree more…I've given up trying to my doctor's medical assistant how to correctly measure BP. I bought an accurate meter and do it at home. I often have to repeat 3 times before I get an accurate reading, apparently simply putting the cuff around my own arm causes my BP to rise.
My issue has been with patients that have short “cone” shaped arms. Then I stress about compressing a nerve and causing injury especially with automatic BP cuffs.
Mary Cancelliere I have short arms and I hate those automatic cuffs. They flippen hurt and they just leave them on so you're stuck getting pinched and bruised on a regular basis.
There is a technique for that
You can do it on the forearm. I wish I had access to the video that showed how to do it.
@@garlicgirl3149 🙋♀️ I resemble that description. When I go in for procedures, the automatic cuff always gives me lines of bruises and then slides down my arm. The nurses end up placing the cuff over my upper forearm and elbow. The best ones that listen start with it there.
I think this doctor hit the nail on the head! I have known how to take blood pressure for over a decade.. BUT! I still allowed my poor readings to be the rule rather than the exception. How did i stop it? I bought a very good BP monitor. I take my blood pressure 3x-4x/ week and i go to my apple health app and go to Blood pressure and go to the upper Right and press add data.. may seem silly-hopefully one day there will be an automatic add to the app. I then go to any office, my Endodonist, my dentist, my physician, even when i donate blood i hold that up and show the best information over many months.. an average! I do take it after relaxing in a chair for 5 mins. Resting for a doctor’s visit? That’s funny.. that’s 1/3 of your visit time gone! Doctor is right.. your blood pressure isnt supposed to be the same ALL DAY, it goes up when we walk, when we are driving when we hit the gym.. thats normal. So if you want a decent baseline, do it in the morning. For me its 11, I’ve walked, ive been home relaxed. For others it may be earlier. But, before noon is better. We should invest in ourselves and take our own readings. It doesnt mean the doctor cannot take his, but, he would certainly love to see what an average is over 1 year over 1 reading. Plus it sends the message that you are a partner with your doctor in your healthcare. When your wrap the BP monitor cuff around your arm I always make sure the tube is directly in alignment with the vein in the center of the inside of my elbow. And i rest my arm , even with the height of my heart.. i also try to avoid sitting on chairs or side of tables where you are pressing down on your femoral arteries and perhaps raising your pressure a bit.. sit on your buttocks.
Have been certified as an EMT for forty years. Yes, we don't have ideal conditions out of facility, but we do the best we can. Some of the techs/LPNs/RNs that take my pressure at the Doctor office have tried to convince me that "Oh its ok if I put the cuff over your sleeve" It got so with one on them I yanked my shirt off. Some use the wrist electronic cuff. (My podiatrist) I am skeptical about regular electronic BP cuffs, but I guess that is because I am getting to be a relic.
This is terrific! Patients can insist on these things for themselves if their healthcare team isn't doing them. Thanks for helping us to be our own caregivers and advocates, in communication with our healthcare providers. ❤
Yeah finally This has been one of my pet peeves So glad you cover the key points in taking B/P
Well this informs me I've never had a proper blood pressure measurement.
I'm always nervous and chattering away because of "white coat syndrome", I'm swinging my feet and the cuff is too tight so I'm grimacing in discomfort.
If I show this to my doctor they might get offended but I'd like them to know these things.
Yup; basic competence is just as important as bedside manner.😮
If your Doctor gets offended... Fire'm !
They are paid by YOU, make them do what you want.
They Serve You !
☆
"blood pressure is a primary diagnostic and taking it wrong is malpractice" yep, gotcha. I nail the nurses on this every time... every goddamned time. I take the cuff off, pull my shirt up, re-fit the cuff and re-attach the hose. There are lines on these damned things and body-form diagrams and weight ranges and instructions and they ignore all of it. One came in and threw it on my arm like it was some kind of 1920's trendy italian neck scarf and punched the go button THEN TRIED TO FIGHT ME WHEN I TOOK IT OFF TO TURN IT OVER.
My rule of thumb is simple - If I can't feel my own pulse in my eyeballs an the damned cuff hurts the moment it inflates then it is on wrong.
I just love it (not) when they call my name, I book it down the hall, they sit me down and take my blood pressure. Hey dude, you're supposed to give me a few minutes to return to rest. And that's why the doctor makes you retake it after I have been sitting and relaxing. Don't take the BP after the sprint! 🏃
Yep...except first they raise my anxiety and likely my BP by taking my weight. Then into a room, sit in the chair, take BP while asking me questions
I love you!!! This is what I'm dealing with right now. Great timing for me. I have a great Dr who has hesitated putting me on meds.....for all the reasons you mentioned.
My doctor wanted to start me on BP meds because it's always high in the office. I work in a hospital and started having my Coworkers take and sign off on my BP several times ahead of a visit, she finally stopped pushing meds when she saw evidence that I don't really have high blood pressure. When I have it taken at work I am able to be sure it's done "right" but that's not how it's done in her office, it's also not how it's done for our annual insurance physicals.
THANK YOU! I am very fortunate to have a primary care doctor that does all the things you mention in the video. Prior to him being my doctor I would routinely have "high blood pressure". My PCP determined that I was having 'white coat syndrome', where anytime a medical professional took my BP it would immediately go up. It wasn't until he took the time to test me (with everything you mentioned) that I discovered I didn't have high BP. Thank you for this video!
Keep that doctor!👍🏽
I'm an RN now, but I was a CNA for about 6 years while I put myself through school. I worked under several nurses on a surgical floor that wouldnt accept a high BP reading. They made me check every limb, and multiple cuff sizes until I got a read they liked. Seriously pissed me off. Which number was the right one? Nuts.
THANK YOU.
As a nurse, I always drill this into the minds of the nurses I train.
Everything you said , I’ve had to correct health workers for every time. I will make them stop or wait. I will move chairs in the office so I don’t have to sit on the exam table. Oh, and I stopped taking medication because I was passing out. Never needed it!
I have a blood pressure horror story to tell you.
I was at the VA (couldn't afford insurance). Several times my BP was taken by NPs, not doctors, and they got high readings (according to them). So, I put myself on a regimen of taking it every day for a month 3 times a day (morning, afternoon and evening). I took it 3 times at each session ( after 15 minutes of relaxing, 5 minutes later and 5 minutes later) and averaged the readings out. I then put every reading into a chart for the whole 30 days.
On my next visit I took my chart with me. No where in the chart was HBP even indicated. After she took the BP and saw it a "little high" I gave her the chart. She BARELY GLANCED at it and literally tossed it back at me. Then, at the next meeting she prescribed hydrochlorothiazide. Me, not knowing any better took it.
Within 2 weeks I was at the VA ER with tachycardia. The so-called ER doctors, who had total access to my records, did nothing. They could have easily looked at my records and noticed I was on hydrochlorothiazide then looked at the side effects of the drug and noticed that two of the major side effects ARE tachycardia and arrhythmia. But they apparently weren't smart enough to do that. So, I was not taken off of the drug.
Well, two weeks later I was back in the ER with tachycardia. And instead of taking me off hydrochlorothiazide they put me on another drug, Metroprolol. This didn't do anything positive. It didn't slow down the heart rate but made my heart feel like it was going to explode through my chest. I told the NP this and she just sat there looking at me like I was a child complaining about the broccoli on my plate. BTW, I looked Metroprolol up in the PDR and it showed researche found it would either slow the heart rate, do nothing or make it worse. Well I came out in the latter.
Well, this went on for at least 5 years until I was FINALLY taken off the hydrochlorothiazide and put on Amlodipine. It took her that long to figure out the original drug wasn't working. By this time I was in full-blown Atrial Fibrillation.
Several years later I read Dr. Stephen Sinatra's protocol for Afib. He used d-ribose instead of Metroprolol. That actually worked. It didn't stop the Afib but my heart didn't feel like it was going to explode out my chest anymore.
Then, several years later the VA gave me a real doctor. I told him my story and he said that I should have immediately been taken off the hydrochlorothiazide. Finally!!! Some vindication! In all the years at the VA my BP was taken properly only TWICE. Some of the places and how and where my BP were taken and the anger and anxiety due to how I was treated by the VA, it is no wonder I had HBP. Quite literally none of this was taken into account ---- even when I said something about it being incorrect.
It is very interesting to note that the EU has changed their numbers for prehypertension. Instead of the 120/80 as in the U.S. it's 140/90. There's a lot more research going on outside the U.S. in hypertension than in the U.S. In the U.S. it was all so cut-and-dry decades ago.
Look up: "Historical Perspectives in the Management of Hypertension" by Marvin Moser in Journal of Clinical Hypertension SPPL. 2 Vol. 2 No. 2 August 2006
trust yourself, doctor don't know jack
I had never heard of white coat syndrome until three years ago when I was in a hospital being evaluated for a minor surgical procedure {reducing a Dupuytren contracture} that needed general anaesthetic for this elderly man {age 71 at the time}. All the nurses & doctors I was sent to checked my blood pressure without time for me to relax. I got the surgery which was a great success, but the next time I saw my GP she was concerned about my BP. I bought an inexpensive machine with an upper arm cuff & stared daily morning measurements & diarizing them in a spreadsheet on my kitchen table laptop computer. I now have just over 2 1/2 years of BP data - fascinating - I can see lots of variation depending on how patient I am to wait out a rest period, whether I've just watched some disturbing news videos, whether I'm angry or happy, etc etc. I printed out the first seven months of data for my annual GP visit 2 years ago, & she was amazed to see the plots. She had never before seen a diary with so much information, especially the variations in BP depending so critically on my mood, resting duration, etc. etc. My numbers are high but below the "danger thresholds" of 160/90 for a man my age 95% of the time. She advised me to continue the diarizing & to contact her for a consult if/when the numbers got worse. So far, so good. The lesson - BP data can be tricky to get right, but it can be done with a little practice.