The case of the man with no blood pressure: solution

The answer is choice number 2. Jim should stop trying so hard.

Unbeknownst to Jim (our young medical student), Mr. Khoury’s increasingly uncomfortable (and discoloured arm) was a clue that Jim was overdoing it. If one’s blood pressure is checked repeatedly, without time in-between cuff inflations to allow normal blood flow to be restored, blood pools in the arm and dampens the sounds that normal arterial blood flow makes (and it is these sounds which we are listening for when we check someone’s blood pressure). The more times that Jim pumped up that cuff, the worse he was making things. What he should have done is to have waited at least a minute or so between inflations to give poor Mr. Khoury's arm a break. The moral of the story…when something doesn’t make sense in medicine, if you are the doctor, ask yourself if the problem is yours, not your patient's!

By the way, this is the format I use in my book (What Your Doctor Really Thinks).

Old cases of the month can be found here.