Americans.

Morning report today focused on long-term care of patients with chronic conditions like diabetes or hypertension and the difficulties we are faced with in that area. So the first case was on a 64-year-old african american female who was - of course - overweight. We were told the story of how she started out on one medication in 2003 and when her blood pressures never responded in subsequent clinic visits, how her regimen was gradually extended to four different blood pressure medications.

At this point in the slide show, the next slide posed the question "what else can you think of to optimize treatment of this patient's hypertension?" to the audience. I was convinced that I knew what this slide was going to show. To my surprise, what they were looking for here were the questions "is the patient taking her medications?" - all right, good one. "Can the patient afford her medications?" - uhm, I see. "Does the patient have access to her medications?" - as in - can she get her obese self to the pharmacy and back? I guess that's a valid question too. But that was it.

Whatever happened to "Did anyone ever talk to this patient about less McDonalds and more exercise?" Is educating people about sodium intake and physical exercise and the likes of that so out of fashion that it doesn't even come up in a discussion of the management of primary hypertension?