Outpatient Medicine and Cards

This week is my last week of outpatient medicine. I still have general medicine clinic in the mornings, but now my afternoon specialty outpatient clinics are in cardiology. Many of the patients are here to follow up for pacemaker placements or MIs (heart attacks). But I had one patient whose cardiac problems were at least in part due to psychiatric problems. She told me that she measures her blood pressure every hour or two, at least a dozen times a day. She always brings her home cuff and the meds with her to work so she could take both all day long. She was worried because her pressure is always high, and she takes extra blood pressure meds whenever it's too high. The problem now is that sometimes she was getting dizzy and feeling like she might faint.

I wasn't quite sure what to do. Usually, we can't get patients with high blood pressure to take their blood pressures and meds consistently. This was the first time I had seen a patient who was massively overdoing the monitoring and taking too much medication! She had kept a thorough record of every reading from the past month, and not even one of her measurements was above normal (120/80). So I explained all of this to the attending, and then we went in to see the patient. The attending explained to her that she shouldn't take her blood pressure more than once or twice a day at most, because worrying so much about her blood pressure was probably making it higher. He also told her not to take more of the meds than had been prescribed. I could see that the patient was skeptical though. Now that I'm thinking about it, we should have probably referred her to psych, because she's obviously obsessive-compulsive enough that it's affecting her quality of life.