Cardiologists Role

[mainframe]

I'm wondering about the role my Cardiologist should play in my after surgery care. My question really centers around my expectations and what they should be.

I originally was referred by my primary physician to a cardiologist who was at the same clinic. I called the surgeons office who I thought would probably do the surgery and got a referral to a cardiologist at the same hospital. After meeting with both, I decided to go with the cardiologist at the hospital, referred by the surgeon.

Since this is a teaching hospital, I often see the "fellow", who is a very nice fellow. hahaha. Then the cardiologist pops in for a few minutes. This doesn't bother me much. Here's where my concern is. I was in the hospital (same hospital where the cardiologist works) for 4 days right after my surgery. Two weeks later, I was back in the hospital for 4 more days having fun with A-fib and a few clots. Not once did my cardiologist come to see me.

That's what bugs me. I'm thinking that I've chosen a particular cardiologist to provide care. At what point does she actually provide care. When everything is going great? I guess it would have been my expectation that at least the second time I was in the hospital, she would have been part of planning for my care, rather than a resident I didn't even meet during the 4 days. It would have been nice for her to drop by and say "here's what we are doing". The reality is I asked that she be paged on the second day, and never heard anything from her.

So my question for the day. Should I expect that if I were to have another cardiac event requiring hospitalization, that my cardiologist will not be part of my care which will be left to whoever happens to be there, or should I find another cardiologist. I'm not expecting Dr. Welby, but at least participation would be nice.

 

[RobThatsMe]

Hi mainframe,

When my surgeon released me from his care, he also mentioned that I should see my primary for followup and Coumadin adustments, etc. Well, since I had a dissection, I told him that I thought I should be seeing a doctor that speicalizes in heart care.
He listened and agreed, so I now see my cardiologist on an annual basis, and also see my primary on an annual basis. I stagger this appointments so that I see one every 6 months. I figure I have pretty good coverage that way. I'll see my cardiologist in April, my primary in Oct, then my cadiologist the following April, and the cycle continues. This way, I get the benefit of both with checkups every 6 months.

My cardiologist is very caring, and always returns my calls. I know that he will be there for me if I need him. If you don't have the confidence in yours, I would suggest that you search for a new one and "Interview" them. Then select one that you have confidence with.

Good luck,

Rob

 

[Ron K]

Time for a change!

Time for a change!

Chris,

When I was in the hospital following my AVR, my surgeon saw me 4 times and my cardiologist saw me at least 4 times, although I don't remember seeing them that often. However, my family was there and talked with them both each time. Other than that, I was checked by fellows.

I have been released by my surgeon, but I am being followed by my cardiologist for heart related issues, and by my PCP for everything else. I'll have my first post-op echocardiogram in mid May.

If you expect to be seen by your cardiologist, especially when you are having serious cardiology problems, then be sure to discuss this with the MD that you are considering to be your cardiologist. Obviously, your current cardiologist doesn't feel that this is important, so find one who does.

You have to have someone that you have a lot of confidence in and who you can trust to be there when you need him/her.

Good luck finding someone better.

Ron K

 

[hensylee]

Went back to surgeon once after surgery (by-pass) and see my cardiologist annually, unless I should have a problem.

 

[Nancy]

Hi Mainframe-

Joe had quite a go-around after his last surgery when he was admitted back into to the hospital for serum sickness which is a rare problem. His PCP admitted him, and had many, many specialists consulting. They were very good, but they weren't cardiologists, and they starting diagnosing things that were under the purview of his cardiologist, they were very concerned about things that were part and parcel of Joe's heart conditions and were normal for him. When they started talking about doing some invasive procedures which would have compromised his heart surgery, I blew a gasket and requested a cardiologist. I was told that the cardiologist had to be invited to come in to see him, and not just by me, but by his PCP.

I finally made enough of an issue that the cardiology group was "invited". He came in and examined Joe and told me that all of the things that they were concerned about were within the normal range for someone with Joe's particular conditions. I was very relieved.

So the whole point I'm trying to make is that it makes a difference who admits you to the hospital and whom they want to have on their team.

I don't know if this is the case with your situation, but if the cardiologist didn't admit you, and wasn't invited to see you, they can't just walk in to see you.

On the other hand, if they were the admitting doctor and didn't see you, you ought to check out some other option.

I hate medical politics!

That was a longer story than I intended.

P.S. Joe sees his cardiologist about every 6 months to a year, unless something comes up. This is a very good man, who calls back right away and really cares.

 

[Mb]

Hi!

This is actually an interesting thread.

My husband basically has two cardiologists. One local, and one in Boston, who took care of him post surgery.

After surgery, Dr. Boucher stopped in daily to see my husband. At least once at other times during the day, the residents stopped in to check on him. After release, he saw him both at 3 months and 6 months post op. We are returning again in the next month or so, as he is being evaluated for a pacemaker, and other issues. The local cardio, saw my husband about 10 days after he was home, as he was having problems, and he has been in to see him about three times (most recently for the stress echo) since then. We do not go through the PCP to get these appointments, but have to get "referral paperwork" that the cardio's office takes care of. I would never have dreamed that a heart surgery patient could be hospitalized for heart related problems, and his/her cardio not come in. Wow. Faster than a speeding bullet, I would get a cardiologist who cared.

I think a patient has the right to expect professional care, regardless of the sub specialty.

Best wishes.

Marybeth

 

[Zazzy]

Chris, What horrible behaviour from a cardio! Seattle isn't that big!!! My cardio came to see me everyday before and after surgery. I was there for two weeks. I was hospitalized two times after my surgery and not only the cardio saw me... but also my surgeon would pop in to see how I was doing! This was in Spokane.... docs must be a lot friendlier there!

When I thought that I may have to go to The Hutch for a bone marrow transplant I asked my cardio for the name of a good cardio in Seattle. He gave me a name of someone that he trusts. I could find it for you if you want. I've had the same cardio for 13 years and I trust his judgement. Let me know!

Take care,
Zazzy

 

[Sam Scholz]

Time for a new Cardio, I have had one for the last 20 years and the 3-4 times I have been whisked to the hospital for care he has always been there. I don't know if it was luck or what. But the 3 valve surgeries I have had my Cardio and my Primary have always been there for me. Cardio's are doctors first who like to treat patients, then you get the stuffed shirts who prefer the prestige. Sorry I am speaking in generalities, but 5 years working with doctors makes them easy to pick out. Time to get a Cardio who likes treating patients.


Sam

 

[ALCapshaw]

Chris,

Before changing horses (er, cardiologists), if you felt comfortable with him/her at first, I would schedule an appointment to express your concerns and discuss what you want / expect. THEN, if he/she is not willing to provide the service you want / expect, go shopping.

A-fib is pretty common after surgery and definitely gets the patient's attention (been there, done that) but the cardiologists seem to treat it like coming down with a common cold. As long as it converts in a relatively short time, it's not considered to be dangerous (i.e. life threatening).

Now that I think about it, I don't even remember seeing my cardiologist after my bypass surgery. I took a 'next day' cancellation so didn't get much in the way of pre-op education or counciling. I don't recommend that route!

Nancy, what a TROOPER you are ! Joe is very fortunate to have such an astute and assertive advocate ! I expect he owes his survival to your observations and follow up. I'd hire you in a minute to look over my post-op care !

'AL'

 

[Nancy]

Hi Al-

Thanks for the kind words. I really feel that EVERYONE with this surgery and/or other complicated medical situations has to be extremely vigilant with everything that they do or is done to them. When you have complicated problems, sometimes things fall through the cracks.

As time goes on with your medical care and more and more doctors are brought into the scenario, it could happen that you or your significant other will be the only ones who see the total picture. Each doctor has little bits and pieces relating to their own specialty and although they are experts in their field, they might not be aware of all that has gone on. We try very hard to keep Joe's PCP abreast of things as they happen because he really needs to know about it.

Remember my old saying, everything means something to guys and gals like yourself. Every symptom you have means something. Pay attention to your body and do your best to be safe in your health.

You have to be your own best advocate. You only have one patient to worry about, your doctors have hundreds.

 

[mainframe]

Well thanks everyone for the responses. I was trying to figure out whether to make a fuss today at my 5 week checkup with the cardio or not. It's the first time I've seen them since the surgery.

I decided to not make a fuss and just look for another cardio after my next appointment in early June. Both that fact that she/they didn't come by while in the hospital, and the fact that typically it's the fellow that I meet with for most of the appointment, then the cardiologist who's supposed to be so great strolls in the last 5 minutes for an appearance, bother me, I guess it's time to get another. It's o.k. to have a cardiologist that supposed to be one of the tops in valve disease, it be even better to feel like I was actually being cared for by her, which I don't.

Chris

 

[ALCapshaw]

I HEAR you Chris. Yep, if you don't feel you are being heard or cared for then it's time to find someone who will do as you wish.

I switched cardiologists for similar reasons. I went back to a guy who specializes in an area different from my problem areas but who had always 'been there' for me in the past. He ran some more tests after my first valve disease diagnosis and immediately cancelled my surgery, telling me that it was not yet warranted. He also worked with me to adjust my medications for optimal benefit and greatly reduced side effects. When it became time for surgery, he referred me to an out of town surgeon and hospital that has a much higher volume of Valve Replacements.

Sometimes it pays to listen to that little 'voice in the back of your head'.

'AL'