Basics #2

So, let’s take a look at a hypothetical situation, even though you know it’s really not all that hypothetical, but whatever.

A certain provider has been observed, over a period of months, to take blood pressures that always ended in zeros and were almost without fail in the same range, i.e. 140/90, 130/80, etc. Well, that’s if he even bothered to take an auscultated blood pressure, and not a lazy palpated one. He also is apparently never able to measure anything under 110 – “I can’t hear it…” – while the next person who handles it never has any trouble getting 82/54 or 66/44.

Kind of a problem, especially if there’s hypotension involved, isn’t it?

No one really says anything, because there is a concern that he’ll just end up making stuff up if anyone points out that his blood pressures are crap, since there really is no real-time way to confirm his measurements. Instead, fellow providers just make sure, on actual legitimate patients, that they don’t waste time letting him take any blood pressures.

At some point, perhaps because someone has spoken to him, he begins to be observed to report blood pressures that are intricately accurate-soundin… uh, I mean, what normal providers obtain, i.e. 124/66, 158/92, etc. It’s also observed that he takes 4 times longer than before to get these numbers.

Seems suspicious.

So now, several possibilities are evident:

Previously Now
  • He was getting shitty blood pressures because he’s a lazy fuck
  • He was making up blood pressures because he’s a lazy fuck
  • He didn’t know how to take blood pressures
  • He is earnestly trying to do better
  • He is taking 4 times longer to make sure he does a good job obtaining blood pressures
  • He is simply making up the new blood pressures now that he’s been called on it
  • He still doesn’t know how to take blood pressures

The logical person would simply conclude that nothing he says is to be believed. Ever.

It’s difficult to see the good in people.

Once you’ve shown that you can’t be trusted, it’s over. And that extends to everything else you do.

6 thoughts on “Basics #2”

  1. It must be very difficult to get an accurate BP, because so many people can’t do it. We have a couple of people just like the one you describe. Only we can’t call them on it, because we’d be insensitive. We just have to work around them.

    1. How do you call them out without actually redoing the BP yourself? Do you direct them away from doing it in the first place?

  2. We had someone like that. Good thing his new full-time fire department just hauls people out to the truck and fires up the NIBP. And it’s also a good thing that like most of our local FDs doing 85% medical runs, his made absolutely no effort to ensure they’re hiring a competent pre-hospital care provider.

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