Blood pressure measurement by family physicians

Hospital-based audits of family physicians are of uncertain utility, since most family physicians conduct community-based practices. We evaluated the feasibility of using a skill-based audit procedure. Blood-pressure measurement is a common and important skill which is often performed poorly by physicians because of a combination of poorly maintained equipment and poor technique. Physicians attending a family-medicine rounds were invited to participate in an evaluation of their skills in taking blood pressure. The usual sphygmomanometer used by the physician was calibrated, and he/she then measured the blood pressure of 10 volunteers, using his/her usual technique. We found that most of the physicians obtained reasonable blood-pressure readings, although there was a significant tendency to produce diastolic readings which were lower than the gold standard (1.6 mmHg.). Eight of the 19 physicians examined demonstrated significant end-digit bias. Two of 16 sphygmomanometers were very badly out of calibration. These results indicate that family physicians can produce accurate blood-pressure readings, but that their technique and equipment would benefit from adjustment.