PA in the VA. Study in UC .

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Sorry forgot to attach article. It is interesting but not surprising that a Neph had not looked a JNC as they rarely get systematic training in HTN.

Seems to me every VA should be doing this systematically.CE Grim MDOn Jun 4, 2012, at 9:19 PM, wrote: I had an appointment with the Neper. at the VA and found out I had a "very rare" disease! That was the start of his training lesson! When I stopped him and told him it accounted for 10% or more of the people with resistnt HTN he tried to pass over it but I didn't let him. After a little discussion he declaired it wasn't that high at the VA! I corrected him again and told him I bet it was and that the problem was that nobody "was smart enough to DX it!" (Sorry ) He pointed out that they "found my case" so I provided the timeline: Adenoma visable on a 2005 scan, renin = 0.1 on 2/22/2007 with a note from the lab "PA probable" and put on Spironolactone on June 2010 and "Proper testing done a month later while on 7 BP meds including Spironolactone!" I thought they might need to refine the procedure! I gave him a copy of the JNC7 reference card on "Prevention, Detection, Evaluation and Treatment of High BP" from NIH. He actually took 5 minutes and reviewed it, thought it was pretty good and tried to give it back. I told it was his to keep and he should start by making sure there was a copy in every treatment area so the PCP's would understand the importance! We then talked a little about NIH and he was very interested. He said most of it wasn't really his responsibility but he would be really intrested in seeing the results of all the testing. I promised him a copy! (Maybe he can shake something loose from the inside!) We wrapped it up with him telling me how much he appreciated having a PTN that cared enough to do the research I had done. He said I was "really challenging his memory"! Probably the best 45 minutes he had spent recently, IMHO. (The PTNs behind me may not agree since we went slightly over our 20 minute allotment!)

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VA study of PA from database 2011.pdf