Shifting the bell curve

The nurse at my doctor's office was checking my blood pressure last week when the following conversation ensued:

Nurse: (trying not to look worried) Um, have you ever had low blood pressure before?
Me:  No.  I've always had normal blood pressure.
Nurse: (now not hiding worry) Well, I'm getting 100/70 for you.
Me:  Yep.  Perfectly normal.

One of the residents today was telling me about a code he attended in the hospital yesterday.  The code was called for hypotension (dangerously low blood pressure).  The resident rushed into the room to find the patient sitting calmly, eating his breakfast.  The nurse informed the resident that the patient's blood pressure was 90/60.

My intention here is not to lambaste nurses.  They are merely following their protocols and experience.  The larger question, I think, is when did reasonable blood pressures become "low"?  Is it just because most of the blood pressures that nurses (and docs, for that matter) see are elevated? 

I can't separate the word "normal" from the picture of a bell curve in my head.  And I have to wonder if the bell curve for "normal" blood pressures isn't starting to shift toward the right.

I don't like the complacency toward a new norm that these events portend.  How can we convince our patients that their blood pressures are too high when the bell curve of normalcy has shifted?  I have started using the word "healthy" to describe desirable blood pressures instead of "normal."

Because, sadly, normal doesn't seem to be healthy anymore.

What's on the menu?

Middle-aged guy in the office today: "So, doc, what do you think of those McDonald's fish sandwiches?"

Another mom about her 13-year-son, recovering from vomiting yesterday, about his first meal post-emesis:
Me: "Have you eaten anything today?"
Mom (answering for him): "He kept down some Burger King nuggets at lunch."

I've seen estimates around 25% for the proportion of Americans who eat fast food every day. (1) 

25%.  Every day.

Yikes.

I know that many of my patients are in this group.  I get it - fast food is cheap, effortless, and filling.* Recognizing these enticements, I struggle to give my patients pragmatic advice about eating healthier foods more often.  I know that they need skills and knowledge that are beyond the scope of my time with them to encourage change.

So, please forgive me as I brag about the efforts of two of my resident advisees.  For their residency community medicine project, they have decided to teach middle school students how to cook healthy foods.  In the first lesson, they showed the students how to chop up vegetables.  Future lessons will include easy recipes and a trip to a farmer's market right in their neighborhood.

How cool is that?  With my public health education, I am often tempted to lament health issues from a broad systems perspective.  I mean, 25%!  Every single day!  How do you make any kind-of a meaningful dent in that?

These two residents have decided to start within their own circle of influence** and make a difference with one group of middle-schoolers.  By giving them practical skills to improve their eating habits, I can only imagine how these two residents may have already changed these students' lives for the better.

If only more of us had their simple ambition, how much more could we accomplish?

(1) http://www.cbsnews.com/stories/2002/01/31/health/main326858.shtml
* Ok, I admit it - I have a total weakness for McDonald's french fries.  But I don't eat them every day...
** Due credit for this concept belongs to Stephen Covey and his 7 Habits of Highly Effective People.