It's midnight, and the phone rings. "Hey doc, this is Dr. Hardy at the emergency department calling about Gregory Hanson, a patient who has had a headache for three days."

[You are on call for your group. The patient is a member of an HMO with which your group has contracted to provide care, but whom you have never seen as a patient.]

Dr. Hardy continues, "He has a history of hypertension and is on Norvasc which he says he is taking regularly. He does have a family history of cerebral aneurysms. Other than the headache and hypertension, his physical examination is unremarkable. I've given him metoprolol I.V. and some clonidine P.O. His blood pressure has been O.K. for a while and then it goes back up. The headache gets worse when his blood pressure rises. The most recent reading was 210/115. I'd like to admit him to stabilize his blood pressure...Doc, are you there?"

What should you tell Dr. Hardy? (Choose the single best answer)
1. Tell the ED physician to observe the patient for another hour, and discharge him if he does not develop focal neurological findings.
2. Start additional oral blood pressure medication and have him follow up in the office the next morning.
3. Refuse to recommend anything as he is not your patient.
4. Approve the admission.



Copyright 2001 David Lickerman, MD