Raymond Ford is a 78-year-old man hospitalized
for evaluation after visiting the
ED because of a severe, persistent headache
he’d had for 24 hours. (This case is
a composite based on my clinical experience.)
On admission to the ED, his blood pressure
was 210/120 mmHg. His blood pressure and pain
are now controlled (140/80 mmHg), and you are
obtaining a health history. When asked what medications
he is taking, Mr. Ford gives a list, including
two drugs prescribed for hypertension: generic hydrochlorothiazide,
a diuretic, and amlodipine (Norvasc),
a calcium channel blocker. Since Mr. Ford’s
blood pressure was so high on admission, you ask
whether he adheres to the medication regimen. “I
don’t take the pills,” he answers. “They don’t let me
function.” When you ask further—“What do you
mean by ‘function’?”—Mr. Ford says, “You know,
those medications don’t let me work down there
when I need to, so I stopped taking them.”
AN APPROACH TO ASSESSING