I was a lab tech during undergrad and grad school. I was applying for a part time, bilingual medical assistant job for a female medical practice. I was trained by a female gynecologist and she just so happened to be the medical director. She was a former instructor at the medical school at the local UC.
She told me that she was impressed with my ability to retain and recall information quickly, as well as my care of the patients so she wanted to personally train me. She personally supervised me for two years in how to do lab work, vitals and other “fun” but messy, clinical skills (centrifuging fluids, autoclaving lots and lots of instruments, etc.).
She was extremely strict on blood pressure. Over and over again, she would state “remember you cannot diagnose someone with a high blood pressure, unless you have attempted that blood pressure in three different settings, and three different environments.”
One of them would be in a soft lit room. Another would be a patient lying down. Another would be midmorning appointments for women who worked. As a last resort and rarely, she would personally go to a patient’s home to take the blood pressure.
She showed me how the ambient environment vastly and, specifically, affected women with high blood pressure readings.
She also showed me how to take a blood pressure so that I didn’t have to go as high on the sphygmomanometer (Mercury) to get an accurate blood pressure reading. Everyone was different in the amount of air, in the cuff, needed to cease the blood pressure flow.
If the systolic reading was above 140-200 and the diastolic was at 90, I would immediately tell the patient that the blood pressure was running high, but that I couldn’t say that she had actually had “high blood pressure” because there were lots of factors affecting the BP. Also, that the physician would immediately address it. If the patient was really concerned, and would push me to say why I thought it was high, I would pull out my worn, laminated copy of “What is blood pressure?”, and tell her “I’m not a physician but a lot of factors affect blood pressure. Here’s a list of things that may affect it. Please ask the physician when you’re in the exam room.”
When I was younger my blood pressure ranged from 90/60 to ~110/70. During my pregnancies, I had toxemia and became grossly overweight. I was placed on blood pressure medication. I still take blood pressure medication and it rarely runs above 120/80. I know immediately if my blood pressure runs high during an exam visit. It rarely does.