 Closing Dialogue
Holmes: …And so,
Watson, let us summarize. First, we have reminded ourselves of the burden
of CVD. We have also emphasized that known risk factors exist and that
modifying them lowers morbidity and mortality. Second, we did some
preparatory work. We learned to use three basic features of the electronic
medical record and how to revise the patient problem lists. Finally, we
have devised appropriate screening and monitoring protocols.
All this being done, the road is now open for implementing a systematic
approach to cardiovascular risk reduction in primary care.
Watson: A systematic approach indeed! Well done, Holmes.
H: You are most kind, Watson. Still, I am eager to hear your
comments.
W: Well, there are two matters that need to be clarified. The first
regards the monitoring process itself.
H: You have my undivided attention.
W: Your monitoring process is focused on repetitive identification,
quantification and modification of cardiovascular risk factors. It does not
deal with the issue of target-organ complications.
H: Quite true. There are two reasons for this. The first is that risk
factor modification is the most efficient means of preventing or reducing
target-organ complications. The second is that target-organ assessment is
part of the well-rehearsed clinical routine of the primary care physician,
the essentials of which are outlined in a multitude of textbooks.
W: As I should well know!! The second matter regards the monitoring
intervals. What is to be done when a risk factor is not under sufficient
control? Certainly, one should not wait until the next monitoring cycle?
H: Certainly not! Each monitoring cycle culminates in operative
conclusions. If these include a need for further modification of one or more
risk factors, this should be carried out immediately until a satisfactory
level of control is gained.
W: And the monitoring interval should be set independently as already
discussed.
H: Exactly. For every patient, regular monitoring intervals ensure
that a review of their cardiovascular risk factor status is performed,
regardless of the amount of medical attention they have received between
monitoring cycles.
W: One more question, Holmes. May I have the pleasure of your company
for a nightcap at the Red Lion? A long interval has past since we last
monitored that pleasant tavern.
H: My goodness, right you are, Watson! We must resolve to adopt a
more systematic approach in the future. After you. |