Me: Your blood pressure is still really high, even though we raised the dose of your medication. Are you forgetting to take it sometimes?
Patient: No, I’m taking it every day. Hey, do you think it’s because I eat a lot of fast food?
Me (practically salivating at this perfect opening for dietary counseling): Well, that’s a really, really great question. Fast food is really high in sodium, which is salt. And eating a lot of salt can raise your blood pressure.
Patient: Oh. What has a lot of salt in it?
Me: Tell me what you ate yesterday, starting with breakfast.
Patient: I had coffee and a donut. Then, after church, we went to Homestyle Buffet and I had fried chicken, mashed potatoes, salad and ice cream. For dinner I had Taco Bell.
Me: There’s several things there that have a lot of sodium. The fried chicken and the Taco Bell are really high in sodium. You might not guess, but the mashed potatoes and salad dressing are also really high in sodium. Any kind of sauce, like bbq sauce, also has a lot of sodium.
Me (starting to get really fired up): I’m printing you a handout right now about which foods are high in sodium. If you can reduce the amount of salt that you eat, we might not have to add another blood pressure medication.
Patient: No, why don’t you just give me the pills.
Me: What? You don’t want to try to cut back on the salt?
Patient: Naw, I don’t think I can do it. You might as well just give me the medicine.
Me, crestfallen: Ok, but take this handout, too. I still want to you cut back on your salt even if you are on more medicine.