May Be Time to Fire a Cardio

[Superbob]

We've moved a couple of times since my '05 surgery, so I've been in the market for a new cardiologist a few times.

At every cardiologist, the standard procedure has been (a) to have an echo done, then (b) have a follow-up with the cardio a week later to discuss the results, good or bad.

Until now.

I had an echo done May 14. But the cardio's office says my regular annual checkup is in October, so no appointment is needed til then. Said someone would call with my results. Someone did, but I was out doing errands. They were told to call back in an hour. They didn't. I called myself a day later. They said, oh, she's gone for the day, want her to call you back first thing Monday morning.? She didn't. I have asked for written results. None yet.

I am getting ticked off. I am thinking it's time to find a new cardio. What is the procedure with you guys? When you have an echo, is there automatically a follow-up to discuss results, good or bad -- or only if the results show cause for concern?

Last October they thought my tests showed a 4.9 aortic aneurysm. My surgeon from '05 said no, what they were seeing was the root replacement device. Still, I live with this thought -- what if the surgeon is wrong? I don't enjoy doctor's appointments but I need to be assured of a little more vigilance from the doc looking after my heart.

 

[ottagal]

Bob,
The typical routine in my case has always been, get the echo a few weeks before the appt. and discuss the findings with the cardiologist at the appt. If you don't feel you are getting the proper care, then it is your perogative to find one who you feel confident with. All the best,

 

[Cozycat]

Bob, just went thru something close to what you did. Was due for a 1 yr check with cardio so called and asked if I could get an echo first and then come in to see him to go over it. They said no, they don't do just a routine echo so needed to see cardio first. Saw him and he's still hearing a slight murmur that's been with me since my AVR surgery so he said to go ahead and schedule an echo. The echo is in a couple of weeks, then I need to wait for about two weeks after the echo and then call to talk to him about what it shows. The sequence doesn't make sense to me (waste of time for all this back & forth stuff), but guess I'll live with it. To get a copy of my echo results have to submit a form to my HMO and then they will send them. As long as they are for my person use, the copies are free. I do like my cardio and have confidence in him, so guess I can bend to their rules. But, if you're iffy about your cardio then it might be time to begin looking for someone you can work with better.

Midge

 

[AgilityDog]

I love my doctor. We do the echo in his office, then I see him immediately thereafter, when he's looked at the results. I love, love, love my doctor.

 

[vtbecca]

We must be spoiled, or maybe it's a pediatric cardiologist thing, but Gabe gets it all done in one visit- check up, EKG and Echo. I'd go crazy if I had to go separate times. I hope to find a cardiologist when he's older who does it the same way. There is a tech who does the echo but the PC always comes in and does at least half of the echo himself so he can get the exact pictures he needs, and then he talks to us right there. It makes for long visits, and usually behind schedule, but it helps to get it all done at the same time. I had a doctor once thyroid issues who did things similar to your doc. Appointment, separate appt. for thyroid ultrasound, and then a follow up appt. Lots of red tape and it was such a pain, and expensive. He had a policy not to talk to patients over the phone-- you had to make a face to face appointment. I was glad when we moved and I got a different doctor. I say if you are unhappy with your situation definitely switch. I don't expect immediate calls back but it seems like your doctor is dragging things out too long.

Becca

 

[Superbob]

Thanks for all the input -- it's really helpful to know what the routine is in other offices. I have a regular appointment with my GP next week, so I may discuss all this with him before making up my mind.

I will say this: When I had the echo done this last time, the echo tech talked to me the whole way and let me look at all the images on the screen, even alluded to some of the numbers. (Not even sure a tech is supposed to do all that.) I gathered from that experience that all was okay, but still shouldn't the cardio go over the results and talk to you about them -- either in person or on the phone?

 

[kfay]

At my local cardio, I do it all in the same appt. Have the echo, which he then looks at, and then see him. I don't necessarily think he gets the best look at it this way, but I always know the results right away. At my yearly appt. at the Mayo, I have all my tests done the day before, then see my cardio the next. She then has the ability to pull up every echo I've had done on split screens so we can see exactly what is going on and if there has been any changes. I think she is a little more thorough than my local, but am happy with both!

Good luck getting your results. If nothing else, I would expect your cardio to give you a quick call to let you know that everything is ok and he'll see you in October.

Kim

 

[Jkm7]

My Cardio's group has three offices. The office where they do the echos is not the one where I see him but all the results go into the computer and can be called up within a day of whichever cardio has studied and commented on the results. My cardio always reads what his associate has commented and studies the echo himself. I like there are two opinions that way.

Because my echo is done in a different office, I usually have an appointment with my cardio within the next week to discuss the results. Some patients are fine waiting weeks for follow up appointment but they know I want the information promptly and always schedule me within 7 days. If I had not made known my desire to not wait, they would probably schedule me further out. They were totally fine when I spoke up.

 

[Bill B]

It's funny how each place does it differently. At Stanford, which you think would be a big, impersonal machine, I got my echo and saw the results in detail with my doctor immediately (30 minutes later). At both my local cardiologists, the echo was a week or so before my appointment, and the review of the results was far less satisfying in terms of details and evaluation than at Stanford. But at least they gave me a copy of the report so I could review it myself later. I think my current cardiologist is pretty good, but, like a lot of doctors, he seems to be struggling with the way modern medicine has forced them to see another patient every 10-15 minutes. I was disappointed when my previous cardiologist entered the exam room and clearly did not remember who I was at the third visit. She clearly did not review my records at all before entering the room. I canned her in favor of my new cardiologist, and although he seems sharper, the same thing happened on my most recent visit with him. I'm just glad I'm essentially healthy and don't need closely monitored, personal care, as I don't think i could get that locally.

 

[DebbyA]

Bob,
This kind of thing is so frustrating. I wonder if it could be a staff problem? I went through a similar spell with my PCP once. When I complained on my next checkup, she said they had three people leave suddenly and therefore three new ones to train at the same time. She also said the doctors always want to know about such breakdowns. If you basically like and respect the cardio, it might be worth a direct contact to find if what you're being told reflects the way the cardio wants to manage your echos.
I've only ever had one cardiologist, and echos and followup consultation appointments are always scheduled.
Sorry you're having this to worry about too.

Debby

 

[Tass]

I changed cardio's from the Kelsey Seybold system to a doc affiliated with the Texas Heart Inst. Transferred my records from Kelsey and went for a visit. New doc reviewed the Kelsey echo and commented that after finding the BAV, they didn't look further for the Coarc (she also made reference to knowing the name of the Kelsey echo tech but wouldn't say anything else). This concerned me, but she was pretty matter of fact-since I went 40 years with it, my body has compensated well enough, etc.

I was still having what i felt (feel) like as being short of breath and she would just refer to the previous echo and said the left ventricle was fine - must be an asthma type thing. I would really like to have her office do an echo (they specialize in echo's) and get a fresh perspective. I was planning on pushing for a new one at the 1 year anny. of the first, but may try for sooner. Had a heart rate monitor (exercise kind) on while mowing the grass this weekend and after 20 minutes of walking behind the mower (late afternoon, not during the hottest part of the day) my heart rate went up to 170. Call me crazy, but that's not 'normal'.

Tass

 

[Mentu]

I just had my first vist with the Cardio since two weeks after surgery 8 months ago. The echo was done on Wednesday and he discussed it with my on Monday. I had a visit with my Primary on Thursday who also had looked at the echo. She sat down and went through it with me which was a lot more informative than the brief summary provided by the Cardio. You might want to discuss your concerns with your PCP who might be able to grease the skids.

Larry

 

[ALCapshaw2]

My Cardio's policy is to schedule the regular Echo's and checkup / office visit consecutively on the same day.
That way he is able to review the tape just before coming to the exam room.

This is a Very Large Group (over 20 Cardio's) with their own Echo Technicians (who seem to be well trained).
I always go to the Records Office (on another floor) on the day of the Echo and sign the Request for Release of Medical Records for my "personal records" and ask that they be provided within 2 weeks. If I don't receive them within that time frame, I contact the records office to pick them up on my next visit (typically to the Coumadin Clinic which is on yet another floor).

 

[buncle]

my cardio's office is about 5 minutes away.i can get an appointment in 2 days from asking. I have and echo done and my Dr. comes in and goes over it right after they do it.
time in the front door till I leave is usually 30-40 minutes. in their office they can do all tests except a cath.I guess if you need a cardio this is a good place to be.

 

[Superbob]

Thanks to all for your help responses,

I think it IS partly an office management/communications problem. But I've found it to be unimproved for nearly a year now, and I would think the doctors would have fixed that by now. The responses of those of you who get the results same-day are very illuminating. I don't see why even a 10-15 minute consult wouldn't be possible after the test. It is just totally frustrating now 10 days later to have not been given the courtesy of some numbers and explanation., Of course, you could say, "no news is good news" -- if something dire had jumped out, presumably they would have contacted me right away. But I think it's time for me to shop around for a better-managed office and attentive cardio.

Thanks again. It has been very helpful to read of others' experiences.

 

[ALCapshaw2]

Bob -

Before you sever ties, it may be worthwhile to meet with your Cardio to express your concerns.
If you can't get an appointment in a timely manner, then a carefully worded letter
expressing your concerns may be an alternative.

Alternatively, you could interview other Cardio's BEFORE you 'cut and run'.
You don't want to be caught without a Cardio who will see you in a timely fashion IF you suddenly become symptomatic.

'AL C'

 

[Superbob]

Bob -

Before you sever ties, it may be worthwhile to meet with your Cardio to express your concerns.
If you can't get an appointment in a timely manner, then a carefully worded letter
expressing your concerns may be an alternative.

Alternatively, you could interview other Cardio's BEFORE you 'cut and run'.
You don't want to be caught without a Cardio who will see you in a timely fashion IF you suddenly become symptomatic.

'AL C'

Good advice, Al. Thanks!

 

[Mileena46]

I have done it both ways...get the echo then see the doctor a week or so later. Last time, I had one without knowing I was going too....meaning he ordered it right then and they did it after my appointment, but the nurse called the next day and told me he was "very pleased" so I certainly think you are not being unreasonable to expect a call even if the news is good.

Mileena

 

[Jkm7]

I always expect a call, letter or office consult after every test. This business about 'if you don't hear from us, it means all is good' does not work for me. How many tests sit unread on desks? Things slip throught the cracks and silence from doctor's office cannot be assumed to be good news IMO Without direct information from my doctors' offices, I assume they never looked at the results. (Call me cynic.)

You have every right to get results of any test in a timely manner - with no attitutde attached from doctor or his staff.

 

[Superbob]

Okay, I've calmed down a bit. Have gotten phone calls, and am getting a written copy of echo report. My ascending aorta is still at 5.1 cm -- about where it was on the CT-scan last fall. When I get the report I will post numbers and ask for input of those of you who understand medspeak.

I guess I am still a confused puppy -- my surgeon reviewed everything last fall and thought the 5.1 was no problem, because the root replacement he installed five years ago accounts for that dimension (he thinks). But my new cardiologist wants to do a repeat echo on six months just to see if there's been any increase in that ascending aorta size. I think that's prudent. What if the surgeon is mistaken? I would think any increase in size would suggest something else is going on. Anyway, I am reassured about my new cardio, if not necessarily about my condition, which is still something of a question mark.