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I had my first appointment with a cardiologist yesterday. There was a lot that I really liked about him and the way he related to me and yet I think there may be two red flags indicating that this is not the best, most careful, most professional cardiologist.
RF #1. During my consultation, he took a phone call from someone on the staff of another clinic and launched into a detailed discussion about the business end of his operation. He finally had the courtesy to finish the call outside the consultation room after I got my own phone out and started acting bored.
RF #2. I tried fulfilling a prescription he wrote me today and the pharmacist found three things wrong with it — there was no quantity included, the dosage he prescribed was not a dosage this drug comes in and, finally, part of the script was illegible.
Obviously, neither of the above are great, but I’m wondering if they are enough to justify looking elsewhere.
Other red flags that you would like to share? I mean, besides overt problems like a bullying attitude and blatant incompetence?
I am one of the most relaxed people on earth and rarely would let too much bother me when it comes to my doctor, but these two things might cause me to do some checking if nothing else. I agree, neither are earth shaking, but they are a bit unusual. Now, I will add, depending on where you live, there seems to be shortage in the medical field so he could just be so busy he had to take the call. The mistake on the prescriptions is a little more serious
I had my first appointment with a cardiologist yesterday. There was a lot that I really liked about him and the way he related to me and yet I think there may be two red flags indicating that this is not the best, most careful, most professional cardiologist.
RF #1. During my consultation, he took a phone call from someone on the staff of another clinic and launched into a detailed discussion about the business end of his operation. He finally had the courtesy to finish the call outside the consultation room after I got my own phone out and started acting bored.
RF #2. I tried fulfilling a prescription he wrote me today and the pharmacist found three things wrong with it — there was no quantity included, the dosage he prescribed was not a dosage this drug comes in and, finally, part of the script was illegible.
Obviously, neither of the above are great, but I’m wondering if they are enough to justify looking elsewhere.
Other red flags that you would like to share? I mean, besides overt problems like a bullying attitude and blatant incompetence?
I'd certainly be put off at having a doctor take a phone call such as you described during my visit, IMO unless it's an emergency of some type, it sends a message to the patient that he/she isn't that important. But I'm told that docs do it sometimes, I'd just hope they don't make it a habit.
In looking up information about use of flecainide as a "pill in the pocket" for paroxysmal atrial fibrillation, (as well as SVT, I see), there are many professional references quoting the success of stopping a-fib episodes in people who have them infrequently. So if that's you, it would seem that this approach by your cardiologist is entirely appropriate. And it seems one of the advantages of taking one dose of a drug infrequently is that you hopefully don't have many side effects, but the drug will be effective in stopping your arrhythmia.
I don't know what to say about the prescription, sounds like it needs to go back to the drawing board. Wonder why the guy didn't send the prescription electronically, which would have necessitated filling in all those blanks before it could be completed.
I guess what still makes me wonder a bit is that you don't mention the cardiologist attempting to get documentation of your arrhythmia, to see if it IS a-fib, or what else it may be. It is very difficult to catch it if it's infrequent, and if it's less than monthly even an event monitor might not do it.
Your infrequent arrthymias may be covered satisfactorily for now, at least, with the PRN flecainide. But especially if the cardiologist you saw is talking anticoagulant for stroke prophylaxis down the road, hopefully that means you will be monitored as time goes by to determine if it really is a-fib, or perhaps another arrythmia for which anticoagulant coverage may not be needed (like SVT).
Thanks everyone. I think I’m going to give him at least one more chance. However, I would certainly not simply let him do a risky procedure on me (i.e. ablation) without doing a lot more research/asking around.
They did wind up getting the prescription straightened out.
@Travelassie — Yes, I would never consent to taking an anti-coagulant without documentation that I really had an on-going problem with afib. He did suggest that I take prescription aspirin every day, but I refused this too. I think my stroke risk is low enough and I already have two different digestive health issues (recurrent diverticulitis, fortunately under control for the time being) and mild drug-induced chronic pancreatitis (from which I am very slowly recovering). The last thing I need is risking a third digestive issue brought on by long-term aspirin use.
Last edited by Jill_Schramm; 11-28-2018 at 04:33 AM..
Reason: Clarity
Most MD's here in Canada don't "write " a prescription. They type it on their computer and then print it out and hand it to you or fax it direct to your pharmacy. Typing not writing, and in a clear easy to read format. Modern technology, right ?
And that's an example of what's wrong with our world; when people think it's abnormal to use their own handwriting. Inaccuracy in writing is bad; writing itself isn't.
Thanks everyone. I think I’m going to give him at least one more chance. However, I would certainly not simply let him do a risky procedure on me (i.e. ablation) without doing a lot more research/asking around.
They did wind up getting the prescription straightened out.
@Travelassie — Yes, I would never consent to taking an anti-coagulant without documentation that I really had an on-going problem with afib. He did suggest that I take prescription aspirin every day, but I refused this too. I think my stroke risk is low enough and I already have two different digestive health issues (recurrent diverticulitis, fortunately under control for the time being) and mild drug-induced chronic pancreatitis (from which I am very slowly recovering). The last thing I need is risking a third digestive issue brought on by long-term aspirin use.
Sounds as though you are wise in regards to your own health. I can't imagine that any cardiologist ( or PCP) would put a patient on anticoagulants without documentation of a condition/conditions where the risk of thrombosis induced strokes outweigh the risks associated with anticoagulants, so sooner or later well before anyone even broaches the topic of anticoagulation with you, your arrthymias will get documented. And if they don't occur often enough or long enough to be recorded on some type of monitor, I'd say you probably don't need it.
I just mention the need for documentation as it's been my experience that one can't always assume an individual will always have the same arrhythmia each time when it recurs. I had been diagnosed with a supraventricular tachycardia (SVT), not a-fib years ago, when I had an episode that wouldn't stop till I was treated with adenosine in the ER. I had had short episodes that always stopped on their own very infrequently since I was a teenager, and assume these were the same type of SVT. But three years ago, another episode that lasted about 3 hours before I took it to the ER and documented there was called a-flutter (which is kind of a more regular type of a-fib, often progresses to afib and is treated the same way). Even though this reverted back to a sinus rhythm about 15 minutes after I got to the ER, they still insisted I be admitted and see a cardiologist.
Which I did when he came in the following day, and for some reason he decided to take me on as a regular patient (after he, his PA who also came, and I had an interesting exchange about my cardiac history, and the nature of arrythmias). I told the hospital staff, this cardiologist and anyone who would listen that I had a history of SVT and couldn't understand how this episode could be anything else.
Well, this cardiologist changed a couple of my medications, took my records, instructed his office two days later to call me and make an appointment with him, and by the way he was ordering a 21 day cardiac monitor to see what was going on.
At that first appointment with this guy, he informed me that the monitor results showed no arrythmias, ( that was the good news), but the bad news was that no doubt the episode that brought me to the hospital WAS atrial flutter, and in his words, "we don't ignore that". He said it's treated like a-fib, including anticoagulation depending on the patient's other risk factors. Since I had had no documented arrhythmias on the monitor results, no other symptoms indicating I had recurrent arrythmia issues since that hospital visit, and was "a smart lady", or so he said, he said he was willing to let the anticoagulation go until I had another episode of a flutter that could be documented. He instructed me to look for it, and go to the ER or perhaps their office to have another EKG if I felt symptoms, and if there was another episode, he would prescribe the anticoagulant. I guess my CHAD-2 risk of stroke was about 3, I think, as I was in my late 60's at the time and had a history of hypertension, had I been younger without that history, perhaps he would not have considered the anticoagulant.
Well, I had a few short episodes- nothing long enough to get anywhere, until two years later where they became frequent again, and that's when he prescribed the wearable two week monitor ( called a Zio Patch, by a company called I-Rhythm) which picked up the SVT, but no afib during that time. Well, while you don't want SVT either it doesn't carry the same risk of thrombosis, so there's no further talk of anticoagulation for me, much to my relief. The cardiologist tripled my dose of metoprolol with these results, and it seems they're considering ablation now.
Sorry about your diverticulitis, I know that is miserable, and pancreatitis is very painful. Sounds as though you've got enough going on with those issues and sure don't need additional cardiac issues. I'd hope that if eventually your providers decide you need anticoagulation, they would carefully evaluate your medical history and current conditions first- but you'll insist they do that, I'm sure. ,
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