Stress at Home?

This question asked by Dr. Nathan Bullington, a third year Internal Medicine resident completing a primary care rotation at Siloam, opened the door to new insights.


Dr. Nathan Bullington, Vanderbilt Resident PGY-3

Dr. Bullington writes…

Ms. “H” had labile blood pressures.  A foreign-born, uninsured female in her late 30s with a diagnosis of hypertension was not uncommon.  However, her blood pressure fluctuations throughout the day were not making sense. 

She would sometimes have low readings before her medicine and high readings afterwards.  Sometimes she would have high readings before then drop her systolic blood pressure by 100 points after the medication. 

I stopped our conversation to ask how her home life had been going. 

“Do you have new stress at home?” I asked.  Immediately her eyes welled with tears and she began crying uncontrollably.  She was having immense difficulty with her son’s behavior along with strong feelings of guilt. 

Thankfully, she was open to meeting with Siloam’s behavioral health consultant and praying with the staff pastor before leaving.  This eliminated the need for any new medicines or medicine changes.

It is not unusual for our residents, students, and staff practitioners to ask one more question – perhaps a rephrased one – that opens the door to deeper pain within our patient’s life that is negatively affecting their physical health.  With this new insight, they are better able to direct a plan of care that addresses the patient as a whole person

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