Sunday, 10 pm on the floor. A nurse reports that her patient is refusing his blood pressure medication for the second night in a row.
Me: Hello, Mr. Logical. I understand you have a concern about your medication tonight?
Mr. Logical: Yes, doc. I'm allergic to it.
Me: Oh, really? What sort of reaction are you having?
Mr. Logical: I don't like how I feel when I take it.
Me: Hmm. That's not quite an allergy, but ok. What do you mean, you don't like how it makes you feel?
Mr. Logical: It slows my heart down.
Me: Yes, that is an expected side effect.
Mr. Logical: Exactly, an allergy!
Me: No, an allergy would be something like a rash or your throat feeling tight. This medication is supposed to lower both your heart rate and your blood pressure. That's what the attending wanted for you.
Mr. Logical: But I don't like it! It's the same damn problem I had with that other medicine, hydralazine. He tried to get me to take that one too. But I refused. I'm allergic. *smiles triumphantly*
Me: Sir, a lowered heart rate is not an allergy. I understand that having a lower heart rate might be a strange sensation for you, but I'm looking at your vitals and your heart rate is quite high. A lowered heart rate in your case would be better for you, not dangerous. And your blood pressure most definitely could use some lowering, too. Having a high blood pressure is very dangerous for your body. Do you want to maybe think about trying this medication? Otherwise, we can try a different one, like clonidine.
Mr. Logical: No! I won't take that one either. They tried to get me to take that before.
Me: So basically, you don't want to take any medications to lower your blood pressure. You prefer the sensation of high blood pressure and pulse.
Mr. Logical: No, I'll take something. I'm just allergic. Make sure they put that on my wrist band.