Surviving Medicine Part 6: Vital Signs, Evidence Based, and Standard of Care

The advent of the scientific method has produced great human triumphs over the vagaries of nature, especially when it comes to healing sick bodies. Modern ‘healthcare’ is a miracle of human ingenuity and business innovation. However, many of the medical treatments on offer today and in the past are not based on any an ethical framework. Much of what the health industry and health authorities both advise and mandate does more harm than good. Money is a factor in the healthcare industry even if it’s offered by the government. In this series, I’m seeking to tell the stories of treatments that are miracle cures, incredible advances, and spectacular disasters. Negotiating the world of doctors, medicines, treatments, and bureaucracies is necessary if one wants to reap the benefits and avoid the disasters.

There are many phrases used in the healthcare system that can be a blessing or a curse, depending on the doctor and the problem. Here are three:

  1. Evidence Based Medicine
  2. Standard of Care
  3. Vital Signs

‘Evidence based medicine’ is both a standard, and a marketing phrase used to denigrate anything that contradicts opinions held by the holder of the “evidence.” Your personal experience or research is not evidence, so your insights into your own biology don’t count. Don’t think you can ‘follow the science’ yourself.

‘Standard of care”’ is defined by the National Cancer Institute as:

Treatment that is accepted by medical experts as a proper treatment for a certain type of disease and that is widely used by healthcare professionals. Also called best practice, standard medical care, and standard therapy.

I’ll cover ‘standard of care’ elsewhere, but for now, note that ‘standard of care’ can be used to justify treatments you don’t need. It is also a phrase that can and has been used to sue doctors, so they will not vary from the standard of care definition regardless of what is good for you.

The third of these, vital signs, are the easiest to know and assume some measure of control. What are vital signs? Traditionally, they are defined as such: Vital signs are measurements of the body’s most basic functions. The four main vital signs routinely monitored by medical professionals and health care providers include the following:

  • Body temperature
  • Pulse rate
  • Respiration rate (rate of breathing)
  • Blood pressure

What do these mean in practice?


The temperature of the human body, also known as thermoregulation, is another easy measure for doctors to take and variance is a clear indication of something going wrong. We’ve heard that every human walks around at 98.6 degrees Fahrenheit, but there is a normal range which is 97.8°F to 99.1°F (36.5°C to 37.3°C) so the AVERAGE is 98.6°F (37°C).

An elevated temperature, what we know as a fever, is the product of the body releasing ‘pyrogens’ into the body, most often as the result of an invader detected by the immune system. There are a variety of conditions that will induce a fever and a few of them are normal and natural, but they induce a fever of 99 degrees, not 104 degrees. Under normal circumstances, the body can heat and cool itself very well, and working out the system of heating and cooling is a core part of body maintenance.

Everyone needs a thermometer, and they need to use it. Tiny variances matter when you’re trying to diagnose yourself.

Pulse (or Heart) Rate

A pulse rate is a measure of how many cycles the heart goes through in one minute, and normal in an adult is anywhere from 60 to 100 BPM or beats per minute. As a general rule, lower is better, kind of like blood pressure, because beats per minute is a good measure of efficiency and if your heart only has to beat 45 beats a minute, and your blood pressure is not low, and you have plenty of oxygen in your blood, and you are breathing normally, that would indicate a very efficient system for carrying around oxygen and other vital supplies to your body.

To get a resting rate, I test myself before I get out of bed in the morning. Rates around 55 are not uncommon, so I’m comfortable with this, but I have noted that my doctor has NEVER recorded this rate. The rate in the doctor’s office is always higher, which I attribute to walking around when they call me back to the examination room and being nervous.

You can also check your heart rate during exercise and in the period after. I’ve checked mine right after a full sprint, and then checked a minute later to gauge how my heart recovers. I have measured 165 BPM after running, and then seen 120 a minute later, and then of course, this is compared to 55 when I’m in a fully relaxed state. This broad range indicates a heart that is functioning normally. A resting heart rate of 100 indicates problems. High resting heart rate is referred to as tachycardia, and it can be temporary or chronic. Chronic tachycardia is a clear indicator of serious heart trouble and will need to be addressed quickly.

Respiration Rate

My doctor rarely checks this when I visit. It is a measure of how many breaths a person takes in a minute and a normal adult takes about 12 to 18 breaths per minute. Doctors use respiration rate as a vital function because oxygen is very important to staying alive and low oxygen saturation, or the measure of how much oxygen is in the blood, is a clear measure of distress if it’s low. A full one third of people who show up at emergency rooms have low levels of oxygen saturation, and if their breathing rate is normal but oxygen is low, the medical staff have a place to start. If the respiratory rate is low, that’s another place to start investigation. A pulse ox meter checks for oxygen saturation and they are cheap to buy and easy to use. It’s that thing they clip to the end of your finger.

Blood Pressure

Your cardiovascular system is a closed loop that uses blood to circulate resources around the body. The blood is being pumped by the heart, and so there is a certain amount of pressure inside the vessels and veins, and the pressure at the peak and valley of each thump of the heart is what is being measured.

The bigger top number is the systolic pressure which just means the pressure right as your heart pumps. The bottom number, called the diastolic pressure, is the lowest ebb of that cycle after your heart has pumped. It really is that simple; it’s just a measure of the pressure inside your veins as your heart beats, with a top and bottom based on the cardiac rhythm. 

As a rule, lower blood pressure is better with a normal range falling between 90/60 to 120/80. Note that blood pressure is a measure of pressure in the moment and that it varies continuously; morning to night, standing versus sitting, if you just ate, male or female and so forth. There are not perfect numbers for all time, but there are trends, the most common of which is hypertension which is chronic high blood pressure. Hypotension is low blood pressure which is far less common.

Chronic high blood pressure is a complex field of study with very few definitive conclusions, and it has been blamed on excessive salt intake in the past. Blood pressure is environmental as well as genetic, but as a measure of health, it’s a good one because it’s generally stable over time and so it can be benchmarked. Consistently high blood pressure IS an indication of something wrong and it can be compared to previous readings. Doctors check it for a reason.

High blood pressure over time is also a major indicator of atherosclerosis, which is a very dangerous condition caused by the buildup of hardened plaques inside the walls of the arteries. Veins and arteries can expand and contract as a way to respond to stimulation of various kinds. Heat, for example, causes your arteries to expand and increases blood flow. This is part of the overall mechanism to cool the body and keep the temperature steady and is why you might get lightheaded in the jacuzzi. As the veins dilate, the volume of blood that can be carried increases but the total amount of blood available does not, and so the overall pressure goes down. The lightheaded feeling is the brain reaction to a decrease in available oxygen. But, if your arteries are clogged with plaques, they harden and can’t dilate and so blood pressure stays high. This is why atherosclerosis is often called hardening of the arteries and the condition sets off a very bad path of negative outcomes including a stroke (cut off of blood to the brain) or a heart attack (cut off of blood to the heart).

A blood pressure cuff is also inexpensive and easy to use, and you can measure your blood pressure regularly and look for trends.

The Fifth Vital Sign

There is reference in the medical literature to a ‘fifth vital sign’ outside of the accepted measures, and has been referred to as the menstrual cycle, blood oxygen saturation, blood glucose levels, and pain. Pain as a vital sign has been a particular problem, and books have been written to describe what happened next. I’ll cover this in other posts, but here is the basic story.

Over time, various government agencies settled on pain as the fifth vital sign with it being reported by the patent on a scale of 1 to 10. This was not without consequence because if pain is a vital sign, the patient report is elevated to the level of an independent reading, like blood pressure, and high levels of pain then demand treatment. That treatment often comes in the form of pain medication, such as various derivatives of opioids. The opioid crisis and thousands of deaths can be traced back to evaluating a subjective measure to the same level as the other objective vital signs. Drug makers pushed the narrative of pain as the fifth vital sign for years to get doctors to use more opioids, and they succeeded. Overdose deaths on a massive scale followed.

Pain is a valid measure, and it is pain that drives people to the doctor, but when treatment for pain is a numbing agent, dangerous territory has been entered. Real, legitimate bodily pain has a cause and drugs are often not the answer. Mental anguish has a cause too, and it is up to you and the medical system to address the issues without simply masking the problem behind numbing drugs, which is sadly a treatment option of first resort for some doctors and many patients.

You Are Your Own Doctor

Here we get back to the evidence-based medicine standard and standard of care protocols. The problem is that doctors will take the vital signs, and feed those metrics into the algorithm of evidence based medicine and apply a standard of care, even though these patterns can obscure real problems and solutions and drive destructive treatments. Why? Because evidence-based medicine precludes the patent’s own experience. If you say “I think my blood pressure is high because I’m going through a divorce,” that is NOT evidence, and the doctor will apply the ‘standard of care’ which is high blood pressure medication, and the medical system will chug along doing what it does. Standard of care can be activity meant to shield the doctor from lawsuit down the road and have absolutely nothing to do what with is good for the patient.

Your only defense is to be sure you know your own metrics and can perform at last self-diagnosis, and the vital signs are a good place to start.

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