Suggest an improvement
-
N/AFix spelling/grammar issueAdd or fix a linkAdd or fix an imageAdd more detailImprove the quality of the writingFix a factual error
-
You don’t need to tell us which article this feedback relates to, as we automatically capture that information for you.
-
This allows us to get in touch for more details if required.
-
Enter a five letter word in lowercase
#gform_wrapper_38 .gform_footer { visibility: hidden; position: absolute; left: -100vw; }
-
This field is for validation purposes and should be left unchanged.
/* = 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find(‘#gform_wrapper_38’);var is_confirmation = jQuery(this).contents().find(‘#gform_confirmation_wrapper_38’).length > 0;var is_redirect = contents.indexOf(‘gformRedirect(){‘) >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery(‘html’).css(‘margin-top’), 10) + parseInt(jQuery(‘body’).css(‘margin-top’), 10) + 100;if(is_form){jQuery(‘#gform_wrapper_38’).html(form_content.html());if(form_content.hasClass(‘gform_validation_error’)){jQuery(‘#gform_wrapper_38’).addClass(‘gform_validation_error’);} else {jQuery(‘#gform_wrapper_38’).removeClass(‘gform_validation_error’);}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery(‘#gform_wrapper_38’).offset().top – mt); }, 50 );if(window[‘gformInitDatepicker’]) {gformInitDatepicker();}if(window[‘gformInitPriceFields’]) {gformInitPriceFields();}var current_page = jQuery(‘#gform_source_page_number_38’).val();gformInitSpinner( 38, ‘https://geekymedics.com/wp-content/plugins/gravityforms/images/spinner.svg’, true );jQuery(document).trigger(‘gform_page_loaded’, [38, current_page]);window[‘gf_submitting_38’] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find(‘.GF_AJAX_POSTBACK’).html();if(!confirmation_content){confirmation_content = contents;}jQuery(‘#gform_wrapper_38’).replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery(‘#gf_38’).offset().top – mt);jQuery(document).trigger(‘gform_confirmation_loaded’, [38]);window[‘gf_submitting_38’] = false;wp.a11y.speak(jQuery(‘#gform_confirmation_message_38’).text());}else{jQuery(‘#gform_38’).append(contents);if(window[‘gformRedirect’]) {gformRedirect();}}jQuery(document).trigger(“gform_pre_post_render”, [{ formId: “38”, currentPage: “current_page”, abort: function() { this.preventDefault(); } }]); if (event && event.defaultPrevented) { return; } const gformWrapperDiv = document.getElementById( “gform_wrapper_38” ); if ( gformWrapperDiv ) { const visibilitySpan = document.createElement( “span” ); visibilitySpan.id = “gform_visibility_test_38”; gformWrapperDiv.insertAdjacentElement( “afterend”, visibilitySpan ); } const visibilityTestDiv = document.getElementById( “gform_visibility_test_38” ); let postRenderFired = false; function triggerPostRender() { if ( postRenderFired ) { return; } postRenderFired = true; jQuery( document ).trigger( ‘gform_post_render’, [38, current_page] ); gform.utils.trigger( { event: ‘gform/postRender’, native: false, data: { formId: 38, currentPage: current_page } } ); gform.utils.trigger( { event: ‘gform/post_render’, native: false, data: { formId: 38, currentPage: current_page } } ); if ( visibilityTestDiv ) { visibilityTestDiv.parentNode.removeChild( visibilityTestDiv ); } } function debounce( func, wait, immediate ) { var timeout; return function() { var context = this, args = arguments; var later = function() { timeout = null; if ( !immediate ) func.apply( context, args ); }; var callNow = immediate && !timeout; clearTimeout( timeout ); timeout = setTimeout( later, wait ); if ( callNow ) func.apply( context, args ); }; } const debouncedTriggerPostRender = debounce( function() { triggerPostRender(); }, 200 ); if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) { const observer = new MutationObserver( ( mutations ) => { mutations.forEach( ( mutation ) => { if ( mutation.type === ‘attributes’ && visibilityTestDiv.offsetParent !== null ) { debouncedTriggerPostRender(); observer.disconnect(); } }); }); observer.observe( document.body, { attributes: true, childList: false, subtree: true, attributeFilter: [ ‘style’, ‘class’ ], }); } else { triggerPostRender(); } } );} );
/* ]]> */
This guide provides a step-by-step approach to explaining a diagnosis of hypertension. In this OSCE explanation guide, the term high blood pressure will be used instead of hypertension when providing example explanations for patients, as it is a more familiar term. You should also read our overview of how to effectively communicate information to patients.
Structuring your explanation
Explaining a diagnosis requires structure and adequate background knowledge of the disease. Whether the information being shared is about a procedure, a new drug or a disease, the BUCES structure (shown below) can be used.
Opening the consultation
Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
BUCES can be used to remember how to structure a consultation in which providing information is the primary focus. Before explaining the various aspects of a disease, it is fundamental to have a common starting point with your patient. This helps to establish rapport and creates an open environment in which the patient can raise concerns, ask questions and gain a better understanding of their problem. After introducing yourself, it is important to take a brief history (this is the first part of the BUCES structure):
- What has brought the patient in to see you today?
- What are their symptoms?
- Are there any risk factors that can be identified? (e.g. lifestyle/family history)
Tip: Practice taking concise histories to get the timing right. In OSCE stations, timing is crucial and you do not want to spend all your time taking a history when you are meant to be explaining a diagnosis! A rough guide would be to keep the introduction and brief history between 1-2 minutes maximum.
What does the patient understand?
Following a brief history, it is important to gauge the patient’s knowledge of their condition. Patients may know someone with the condition, or this may be their first encounter with the disease. Be open with the patient and work to identify any misconceptions they may have. The patient sitting before you may not even know at this point that they have hypertension – you may be the first person to inform them of the diagnosis.
Due to these reasons, it is important to start with open questioning. Good examples include:
- “Do you understand why I wanted to discuss your blood pressure?”
- “Have you heard of high blood pressure before?”
- “What do you know about high blood pressure?”
Open questioning should help you determine what the patient currently understands, allowing you to tailor your explanation to an appropriate level.
At this stage, primarily focus on listening to the patient. It may also be helpful to give positive feedback as the patient talks (i.e. should a patient demonstrate some understanding, reinforce this knowledge with encouraging words and non-verbal communication such as nodding).
Checking the patient’s understanding should not be solely confined to this point of the consultation but should be done throughout by repeatedly ‘chunking and checking’.
Tip: Try using phrases such as: “Just to check that I am explaining the significance of high blood pressure clearly, can you repeat back to me what you understand so far?” This is far better than only saying, “What do you understand so far?” as the onus is placed upon the quality of your explanation rather than there being an issue with the patient’s ability to understand.
What are the patient’s concerns?
The patient’s concerns should never be overlooked. A diagnosis of hypertension can be a significant life event and provoke a variety of worries. Asking the patient if they have any concerns before beginning your explanation allows you to specifically tailor what is most relevant to the patient, placing them at the centre of the explanation. The ICE (ideas, concerns and expectations) format, can provide a useful structure for exploring this area further.
ICE
Ideas
- What is their understanding of hypertension?
Concerns
- What are the patient’s concerns regarding their diagnosis?
Expectations
- What is the patient hoping to get out of the consultation today?
Explanation
After determining the patient’s current level of understanding, you should be able to explain their condition clearly. Avoid medical jargon so as not to confuse your patient.
You should begin by signposting what you are going to explain to give the patient an idea of what to expect.
“I’m going to begin by talking about how the heart and circulation system works, then move on to discuss what high blood pressure is, why it is important to address and how we can manage it together.”
In preparation for your OSCE, practice your explanation in patient-friendly terms. Consider using visual aids such as diagrams or drawings to help understanding.
Tip: Use the mnemonic “Normally We Can Probably Manage” to help you remember the structure of explaining a disease.
Normal anatomy/physiology
“The circulation system within your body is made up of your heart, a muscular pump, and blood vessels.”
“The pressure within the vessels is a combination of how hard the heart pumps and how stretchy the vessels are. This is measured both when the heart pumps – systole, the top number – and when the heart relaxes – diastole, the bottom number.”
For further information, see the Geeky Medics guide to the regulation of blood pressure.
What is hypertension?
“High blood pressure occurs when the vessels become less elastic and more narrow. This means that to pump blood around the body, the heart has to work harder, which increases the pressure in the vessels.”
“It is normal for your blood pressure to go up and down during the day, especially when you are active; however, it should not be consistently greater than 140 over 90.”
Due to the dynamic nature of blood pressure, and phenomena such as the white coat effect, hypertension should be diagnosed using either ambulatory or home blood pressure monitoring.1
- Ambulatory blood pressure monitoring (ABPM): an automated cuff and machine are worn for 24 hours. This takes two readings every hour during waking hours and creates an average of at least 14 readings.
- Home blood pressure monitoring (HBPM): the patient takes blood pressure recordings twice daily for at least four and up to seven days. These are then averaged.
- White coat hypertension: discrepancy of more than 20/10 mmHg between clinic and average ABPM/HBPM measurements.
“Although your blood pressure is high today, this doesn’t necessarily mean you have hypertension. To formally diagnose, I would like for you to be fitted with a machine that takes readings over 24 hours and provides an average.”
For further information, see the Geeky Medics guide to blood pressure measurement.
What are the causes of hypertension?
Most cases of hypertension (90%) are primary hypertension, for which there is no single, underlying, identifiable cause. The other 10% of cases are secondary hypertension, which is due to an underlying disease or drug.1
The exact underlying pathophysiology of hypertension is not agreed upon. However, many risk factors are seen as contributors. These can be divided into non-modifiable and modifiable factors:1
- Non-modifiable: increasing age, genetic factors, ethnicity, gender
- Modifiable: smoking, high salt intake, excessive alcohol or caffeine consumption, physical inactivity
- Modifiable co-existing disease: diabetes mellitus, chronic kidney disease, hyperlipidaemia
“The most common cause of high blood pressure is getting older. However, many factors in your lifestyle can have a significant impact; these include smoking, not getting enough exercise, being overweight, drinking alcohol in excess and a diet high in salt, sugar and fats.”
For further information, see the Geeky Medics guide to hypertension.
Problems/complications of hypertension
It is critical to explain the significance of hypertension as it is a disease commonly without symptoms. Symptoms experienced due to hypertension are a consequence of end-organ damage, which can be fatal.
It is important not to scare the patient but to explain that you are outlining the potential complications so that they are aware of them. A clear explanation is essential so that the patient is informed on how to reduce the likelihood of complications and improve adherence to lifestyle and pharmacological interventions.
“The changes in the cardiovascular system allow for the formation of fatty material, called atheroma, in the vessels, which can cause further narrowing and complications anywhere in the body. You are unlikely to have any symptoms of this; however, it can lead to significant complications if not addressed.”
Ischaemic heart disease
“Fatty deposits can build up so much that the artery which supplies the heart muscle becomes partially or completely blocked; this is called angina or a heart attack. Both of which can lead to permanent damage to the heart and even death.”
Stroke, TIA and vascular dementia
“Fatty deposits can also build up in vessels that supply your brain. If these become blocked, it can cut off the oxygen supply to parts of your brain, leading to a stroke or a type of memory impairment called vascular dementia.”
Chronic kidney disease
“If there is too much pressure in the kidneys, this leads to damage that reduces kidney blood flow. This damage means that the kidneys cannot filter the blood as effectively.”
Peripheral vascular disease
“The narrowing of vessels due to high blood pressure can reduce the circulation to your hands and feet. If this progresses, you can get pain in your limbs when moving and, in the worst-case scenario, can lead to amputation.”
Management
Normal blood pressure can usually be achieved with the right lifestyle changes and medical treatment. However, because the condition is asymptomatic, patients might not notice any change, and therefore, they need to be regularly monitored.
“Our target in managing your high blood pressure is to reduce it below a target range. You are unlikely to have any symptoms of high blood pressure, so it must be regularly monitored to ensure we are always maintaining this target.”
Explain to the patient that there are steps they can take in their own lives and things you will do as their doctor.
“We recommend a combination of healthy lifestyle changes and long-term medications. I can explain and discuss these options with you in more detail so you understand how they will help.”
Non-pharmacological
All patients with hypertension should be encouraged to adopt several lifestyle changes.
“In addition to the medication, you can make some lifestyle changes that lower your blood pressure and help reduce the risk of associated complications.”
Start by explaining what the patient can do to manage their condition, including:1
- Smoking cessation
- Weight loss if the patient is overweight or obese
- Undertaking at least 150 minutes of moderate physical activity a week
- Limit salt, caffeine and alcohol intake
- Eating a cardioprotective diet low in saturated fats, transaturated fats and cholesterol. Encourage fruits, vegetables, whole grains, nuts, and oily fish
It can be useful to signpost patients to resources such as NHS Better Health, which provides information and support for lifestyle interventions.
Pharmacological
Pharmacological treatments are used in managing hypertension; however, they should support lifestyle changes and not be a replacement. Many people may be able to lower their blood pressure to a normal range with lifestyle changes alone, so the ongoing use of medications should be regularly reviewed.
“If you are unable to lower your blood pressure with lifestyle changes alone, medications can be used long-term to support. It is important to routinely monitor your blood pressure to ensure it is neither too high nor being lowered too much, as the latter can cause side effects such as feeling lightheaded.”
QRISK
QRISK is a tool used to calculate an individual’s 10-year risk of developing a major cardiovascular event. This incorporates demographic and disease data about a patient, including blood pressure, to give a risk score. Scores above 10% are high risk, and these patients should be offered lipid-lowering therapy, such as a statin, regardless of their serum cholesterol.2-3
“When considering your blood pressure, along with factors such as age, BMI and your past medical history, we can estimate your risk of developing a heart attack or stroke over the next 10 years. When this value is above 10%, you are considered high risk and would be advised to take a medication called a statin to reduce this risk”.
Closing the consultation
Summarise the key points back to the patient.
“We have discussed quite a lot today, including high blood pressure, how the condition is managed and the possible complications. I realise this is a lot of information to take in, so I have a leaflet summarising everything we’ve discussed. It is also important that you regularly monitor your blood pressure as you may not have symptoms if it worsens.”
Ask the patient if they have any questions or concerns that have not been addressed.
“Is there anything I have explained that you’d like me to go over again?”
“Do you have any other questions before we finish?”
Offer the patient some leaflets on hypertension and its management and direct them to reliable websites to gather more information (examples include Blood Pressure UK and NHS conditions).
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Editor
Dr Jamie Scriven
References
- NICE. Hypertension in adults: diagnosis and management (NG136). 2023. Available from: [LINK].
- NICE CKS. Lipid modification: CVD prevention. 2024. Available from: [LINK].
- Hippisley-Cox J, Coupland C, Robson J, et al. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017. Available from: [LINK].
Discover more from Bibliobazar Digi Books
Subscribe to get the latest posts sent to your email.
![First Aid (Quick Study Health) PDF Free Download [Direct Link]](https://bazarbiblio.com/wp-content/uploads/2024/02/First-Aid-Quick-Study-Health-PDF.jpg)