4 ms·

I was listening to Peter Attia on some podcast and he says to essentially throw out any BP reading that didn't occur after sitting down for five minutes. In his

I was listening to Peter Attia on some podcast and he says to essentially throw out any BP reading that didn't occur after sitting down for five minutes. In his practice they have patients measure many times a day for multiple weeks just to get a baseline point to work from. More and more i find that, at least in America, if you're talking to a GP you're just talking to a human interface of insurance approved treatment algorithms.

electric_mayhem 4y ago
That’s a great way to articulate the problem. Imho, a brilliant solution is direct primary care. For $80/mo, I have access to a dr that works for me, and not my insurance company. Absolute game changer in that he has a bias toward understanding and optimizing rather than gaming insurance metrics to be rated as a double-plus preferred provider or whatever. Also gets my lab work done at a fraction of what my insurance deductible would be. Combine it with a high deductible insurance plan to hedge against the truly catastrophic/expensive possibilities. There are direct primary care providers all over. Google it. I can’t recommend direct primary care highly enough.
- Arborealist 4y ago
  Is this the same thing as concierge medicine? I’m interested but it seems quite expensive. 80$ a month seems much lower than normal.
  - electric_mayhem 4y ago
    I honestly don’t know if ‘concierge medicine’ is a different thing, but from what it sounds like and my own experience with direct primary care they sound equivalent. Possibly different by cost or target demographic. A rose by any other name, and all that.
    - ctennis1 4y ago
      We have DPC, and it's amazing. We pay $250/month for a family of 4. Some places charge less, but then also charge you for each time you see the doctor. Ours is all inclusive except for any in office incidentals - like lab work. It's truly amazing. Our doctor knows us all well, can get responses to email or text within just a few minutes, generally same day appointments, or next day if she's really busy. Most things we don't even need to go in for - I did a recent international trip, and she just ordered me all of the needed travel medications without having to stop in.
      - Arborealist 4y ago
        Thanks. I might try this out for a year. Can’t be worse than my current experience of only seeing a NP for 5 minutes.
        electric_mayhem 4y ago
        I think you’ll be very pleasantly surprised. Consider talking to a couple local dpc providers and see which you feel you’d work best with.
        wyldberry 4y ago
        At this point, I just reschedule if it looks like im seeing an NP or PA-C and the time is only going to be 10 minutes or less.
  - wswope 4y ago
    DPC is just concierge-lite; the difference basically comes down to the head count that the provider wants for their practice. A lot of docs do DPC for a while to build up a client base, then exit to concierge, keeping a third of their previous roster at three times the cost.
  - howard941 4y ago
    I don't know how to get around this problem but wife and I paid $1,500 for a year's worth of concierge care only to have the physician close up shop after 4 months. I suppose if we paid month-by-month that would have helped.
nradov 4y ago
Dr. Attia also shared his personal experience similar to @sklargh's grandfather where he suffered a head injury after fainting while standing up from bed. High blood pressure can kill you over years, but excessive low blood pressure can kill you tomorrow.
giantg2 4y ago
In America we also (mis)use blood pressure machines. I'd better quality or used correctly, they're usually ok. However, I've had nurses just crank the thing up to 200. No shit it's going to be high - it cut off my circulation for 90 seconds while it climbs all the way up and then all the way down. I can feel my pulse increase in force trying to get blood to my numb arm. Let's be lazy and let the machine do everything for us. "More and more i find that, at least in America, if you're talking to a GP you're just talking to a human interface of insurance approved treatment algorithms." I largely agree, although from a slightly different angle. Many newer doctors just read from their Epic WebMd equivalent and record your answers. I assume it's so they don't get sued.
StillBored 4y ago
Yah, I purchased one of the automatic monitoring machines at home after having a couple slightly elevated readings at dentist/etc offices. And what I learned is that I can swing my blood pressure from slightly low to slightly elevated simply by how I sit, how relaxed I am, and untold other variables that result in being able to consciously swing it 20+ mmHg, and other times it can swing that much (or more) just between multiple consecutive readings where I don't move/etc between them. I've also had Nurses swap the Cuff size and drop that much, or just do two in a row in the Dr's office and get massively different results. So, for me, I don't know how to determine an actual bp if the noise is greater than the signal. Taking the average over multiple times a day, for a few weeks is probably reasonable. But then, I'm pretty sure the amount of exercise and what I eat day to day could swing it one way or the other depending on the time of the year (aka I sweat a lot more during the summer and drop weight, etc).
- atomicnumber3 4y ago
  I was laid off in November, coincidentally on the same day I had a doctors exam. I didn't want to reschedule it so I went. My BP was suddenly 150-160. They were somewhat concerned (I'm young and almost an underweight BMI) until I explained I just got laid off about 4 hours ago. Fun stuff. Weird memory.
jrootabega 4y ago
I did this for the doctor, and my pressure readings were much better at home, which should be no surprise. They asked me to bring in the machine to check it against their own measurements. It takes three readings a minute apart, and then does its calculations to produce the numbers. After the first cycle, the assistant wanted nothing to do with it, and started fiddling with the machine in annoyance to get it to do whatever she wanted. There was not even a discussion about it. There must have been many other sides of beef in the office that she had to hurry to poke and prod as fast as possible. And what do you know, I think that visit produced the highest blood pressure they had seen in me yet. I think that was the same visit I had to point out that their fridge with blood samples in it wasn't closed fully. The doctor made it a point to stop and ask me if something was bothering me that visit because my frustration at how bad US general practice had become was obvious.
Alex3917 4y ago
> I was listening to Peter Attia on some podcast and he says to essentially throw out any BP reading that didn't occur after sitting down for five minutes. Or just assume that your systolic will be about 3 points higher if you weren't sitting for five minutes, or whatever the normal correction is for you. You shouldn't accept a diagnosis of high blood pressure from your doctor if (as is most likely) they aren't measuring it correctly, but the deviation from the "correct" measurement also isn't random.

electric_mayhem 4y ago

That’s a great way to articulate the problem. Imho, a brilliant solution is direct primary care. For $80/mo, I have access to a dr that works for me, and not my insurance company. Absolute game changer in that he has a bias toward understanding and optimizing rather than gaming insurance metrics to be rated as a double-plus preferred provider or whatever. Also gets my lab work done at a fraction of what my insurance deductible would be. Combine it with a high deductible insurance plan to hedge against the truly catastrophic/expensive possibilities. There are direct primary care providers all over. Google it. I can’t recommend direct primary care highly enough.

Arborealist 4y ago
Is this the same thing as concierge medicine? I’m interested but it seems quite expensive. 80$ a month seems much lower than normal.
- electric_mayhem 4y ago
  I honestly don’t know if ‘concierge medicine’ is a different thing, but from what it sounds like and my own experience with direct primary care they sound equivalent. Possibly different by cost or target demographic. A rose by any other name, and all that.
  - ctennis1 4y ago
    We have DPC, and it's amazing. We pay $250/month for a family of 4. Some places charge less, but then also charge you for each time you see the doctor. Ours is all inclusive except for any in office incidentals - like lab work. It's truly amazing. Our doctor knows us all well, can get responses to email or text within just a few minutes, generally same day appointments, or next day if she's really busy. Most things we don't even need to go in for - I did a recent international trip, and she just ordered me all of the needed travel medications without having to stop in.
    - Arborealist 4y ago
      Thanks. I might try this out for a year. Can’t be worse than my current experience of only seeing a NP for 5 minutes.
      - electric_mayhem 4y ago
        I think you’ll be very pleasantly surprised. Consider talking to a couple local dpc providers and see which you feel you’d work best with.
      - wyldberry 4y ago
        At this point, I just reschedule if it looks like im seeing an NP or PA-C and the time is only going to be 10 minutes or less.
- wswope 4y ago
  DPC is just concierge-lite; the difference basically comes down to the head count that the provider wants for their practice. A lot of docs do DPC for a while to build up a client base, then exit to concierge, keeping a third of their previous roster at three times the cost.
- howard941 4y ago
  I don't know how to get around this problem but wife and I paid $1,500 for a year's worth of concierge care only to have the physician close up shop after 4 months. I suppose if we paid month-by-month that would have helped.

nradov 4y ago

Dr. Attia also shared his personal experience similar to @sklargh's grandfather where he suffered a head injury after fainting while standing up from bed. High blood pressure can kill you over years, but excessive low blood pressure can kill you tomorrow.

giantg2 4y ago

In America we also (mis)use blood pressure machines. I'd better quality or used correctly, they're usually ok. However, I've had nurses just crank the thing up to 200. No shit it's going to be high - it cut off my circulation for 90 seconds while it climbs all the way up and then all the way down. I can feel my pulse increase in force trying to get blood to my numb arm. Let's be lazy and let the machine do everything for us. "More and more i find that, at least in America, if you're talking to a GP you're just talking to a human interface of insurance approved treatment algorithms." I largely agree, although from a slightly different angle. Many newer doctors just read from their Epic WebMd equivalent and record your answers. I assume it's so they don't get sued.

StillBored 4y ago

Yah, I purchased one of the automatic monitoring machines at home after having a couple slightly elevated readings at dentist/etc offices. And what I learned is that I can swing my blood pressure from slightly low to slightly elevated simply by how I sit, how relaxed I am, and untold other variables that result in being able to consciously swing it 20+ mmHg, and other times it can swing that much (or more) just between multiple consecutive readings where I don't move/etc between them. I've also had Nurses swap the Cuff size and drop that much, or just do two in a row in the Dr's office and get massively different results. So, for me, I don't know how to determine an actual bp if the noise is greater than the signal. Taking the average over multiple times a day, for a few weeks is probably reasonable. But then, I'm pretty sure the amount of exercise and what I eat day to day could swing it one way or the other depending on the time of the year (aka I sweat a lot more during the summer and drop weight, etc).

atomicnumber3 4y ago
I was laid off in November, coincidentally on the same day I had a doctors exam. I didn't want to reschedule it so I went. My BP was suddenly 150-160. They were somewhat concerned (I'm young and almost an underweight BMI) until I explained I just got laid off about 4 hours ago. Fun stuff. Weird memory.

jrootabega 4y ago

I did this for the doctor, and my pressure readings were much better at home, which should be no surprise. They asked me to bring in the machine to check it against their own measurements. It takes three readings a minute apart, and then does its calculations to produce the numbers. After the first cycle, the assistant wanted nothing to do with it, and started fiddling with the machine in annoyance to get it to do whatever she wanted. There was not even a discussion about it. There must have been many other sides of beef in the office that she had to hurry to poke and prod as fast as possible. And what do you know, I think that visit produced the highest blood pressure they had seen in me yet. I think that was the same visit I had to point out that their fridge with blood samples in it wasn't closed fully. The doctor made it a point to stop and ask me if something was bothering me that visit because my frustration at how bad US general practice had become was obvious.

Alex3917 4y ago

> I was listening to Peter Attia on some podcast and he says to essentially throw out any BP reading that didn't occur after sitting down for five minutes. Or just assume that your systolic will be about 3 points higher if you weren't sitting for five minutes, or whatever the normal correction is for you. You shouldn't accept a diagnosis of high blood pressure from your doctor if (as is most likely) they aren't measuring it correctly, but the deviation from the "correct" measurement also isn't random.