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Letter to the editor.

Good evening, Anne. I want to thank you for your editorial in the recent issue of the Cardiopulmonary Journal about evidence "guiding" care vs. "directing" care. I share your experiences with the difficulties navigating our health care system. My Mom, who passed away in 2009, taught me many things during my life. What I learned in trying to be her health care advocate during the last years of her life informed my practice to this day. The bottom line is, "Look at the patient, their life, their desires, and tell me what you see."

Having read the article by Ethel, Ann, and Steve (1) in the recent CVP journal, I want to share a clinical experience I had two days ago in relation to blood pressure monitoring. We were consulted on a patient with a history of AIDS (CD4 count in the 400's) who was admitted with syncope. When I entered the room, there were two medical students trying to ascertain if the individual had orthostatic hypotension. They obtained the resting supine blood pressure, as well as a seated blood pressure. Their assumption given the slight drop in blood pressure between the two positions was that he was posturally hypotensive. I was with them when they had the patient go from sitting to standing during their attempts to measure his blood pressure. As often happens with the electronic digital blood pressure monitors (the reason why I carry my own blood pressure cuff and stethoscope), the unit was not charged properly and rendered an "error message." The medical student was frustrated and tried 3 times to obtain the patient's standing blood pressure. This took about 3-5 minutes during which time the patient was standing independently at the bedside without symptoms. I commented to the medical student that the patient was not experiencing orthostatic hypotension because he was not symptomatic during this upright trial. Her initial comment was, "But we don't have the data." I asked her to LOOK at the patient, feel for diaphoresis and ask the patient about his symptoms - of which he had none. She thanked me for my instruction and notified her attending physician that there must be another reason for the syncope.

I share your concern that we, as health care providers, have become over-sensitized to the need for "hard evidence." It has been documented that we, as health care providers, have evidence for 20% of what we do. There are times when we need to turn off all the monitors and LOOK at the patient. Your editorial speaks to the "art of practice" that we sometimes lose sight of. I am grateful for your candid editorial.


(1.) Frese EM, Fick A, Sadowsky HS. Blood pressure measurement guidelines for physical therapists. Cardiopulm Phys Ther J. 2011;22 (2):5-12.

Mary C. Sinnott, PT, DPT, MEd

Director of the DPT Program, Temple University

Director - APTA Board of Directors
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Author:Sinnott, Mary C.
Publication:Cardiopulmonary Physical Therapy Journal
Article Type:Letter to the editor
Date:Sep 1, 2011
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