I went to see my GP last night holding the print offs from Cardiograph app and with the knowledge that Sotolal is now not recommended for AF. I mentioned to him that my symptoms had changed along with dizziness and again asked for his thoughts on referral. He once again said no to referral as they could tell us no new information, only that I had PAF and that we already new this. At least the Hemotologist is listening so just waiting to hear if the cardio he is speaking to is still willing to see me. GP not impressed with app print offs as he said it only gave one wave not both of them so ignored them. As for meds he said we had three options 1. Come off Sotolal altogether and just take dabigratran 2. Change another beta blocker. He never mentioned the 3rd option or I can't remember one. Conclusion was to start 2.5 of bisoprol once a day from today and stop Sotalol .
Help please: I went to see my GP last... - Atrial Fibrillati...
Help please
I wouldn't ask for my GP's opinion on a referral, I would just say I want to be referred, full stop. Last year I though I had AF and had the tiniest symptoms, a tickling under my arm, that you would only catch on a 7 day monitor. I got a referral on that basis with no evidence whatsoever, and I didn't even know whether it was AF myself. I was referred to the cardio of my choice, who by the way, detected that it was AF and did an ablation (on the NHS). My consultation was private (£150) but I don't think that made a difference because I only mentioned I wanted to to private later in the conversation, not sure though, someone else will know.
Thanks Koll, I get lots of funny feelings in my left arm too. I was diagnosed with PAF back in 2005 having been admitted to hospital in the middle of an episode. It came about after being to the dentist and given adrenalin via an injection for a filling, they suspect it went straight into my blood stream. I appreciate what you are saying about telling him 'I want a referral instead of asking'. I am not confidant he will listen as last year he was asked to refer me to ENT by a health professional after a severe vertigo episode and total loss of hearing in one ear and again he refused. So when a Heamotoligist said he would write to him and request that I see a Cardio again due to the length of time since last referral I said no, which is why he is trying to organise for me direct, as he is interested why adrenalin would cause this to happen. I suppose I wanted to test the ground with my GP again. It's all very frustrating or maybe I ask to much of him.
Poppy please change your doctor. You have the right to be treated by whoever and wherever you choose. This idiot is stopping you getting the best treatment.
Bob
Your GP doesn't sound very helpful, but at least the new beta blocker might be an improvement. There's hope that your ongoing investigations will develop into something too, so surely you are making progress even though your GP isn't really playing ball. Seems a bit short sighted to say referral to a cardio will not add to the picture! You could consider making a private appointment with a cardio or writing to your doctor to make a formal request for a referral if you get no joy.
Your GP doesn't have 3 options, he has 4. The three you mention plus going to a cardio/EP who will find what drugs you need. I wonder how the GP knows you need beta-blockers? That's what my GP did, and my EP took me straight off them within days as I needed drugs that the GP isn't allowed to prescribe, and what he has prescribed works.
Just a thought.
I mentioned Flecainide and he said 'oh no this would be no good for you' I also asked what he thought of taking meds only when PAF happens and he said no to this also as he said the meds would not work quick enough. So maybe the negative answer was because he cannot not prescribe this treatment?
"So maybe the negative answer was because he cannot not prescribe this treatment?"
Exactly what I was thinking.
Get that referral and if you can't, change GP I'd say. Even if nothing comes of it, at least you've got it off your chest and got expert advice. Maybe if you pleaded that this was stressing you out and needed answers, he might give you a referral? I hate it when GP's act as gatekeepers.
_
Thanks Koll for taking an interest x
You have a right to be referred and he can't refuse you!
Especially as your symptoms have changed.
My own EP was less than complimentary about GPs consulting on heart rhythms. They are not consultants and certainly not specialists.
I know it makes us uncomfortable to be put in a position where we have no alternative than to confront but unfortunately that is your path forward here. Try your best to be assertive even if that doesn't come naturally.
When you do get to see an EP and your initial treatment and or tests are finished, (if it goes that way) ask to be kept on his books for a routine appointment in, say, 12 months time rather than be automatically 'signed off' back to your GP. Tell him that you have no faith in your GP etc and would like to stay on his books. I do this.
The cardiograph App, only tells you your heart rate. I know it records as a graph but that is no ECG.
If you can stretch to buying an Alivecor (£169), the recording from that is accepted by Consultants as accurate. They are not as good as a proper 12 lead ECG done at the hospital in as much as it can't record as much detail but what it does record is accurate.
Try to change your GP too, he sounds completely arrogant and intimidating.
When did you last see a consultant?
Easy for me to say but I would dump this GP and either change practice or see a different doctor at your current practice. Your GP appears far too arrogant, in reality what he knows about AF compared to specialist EP's is likely to be minimal.
Its your health being compromised not his/hers. Even if he is proven right in his diagnosis and treatment you still need to have the input and expertise of a specialist.
Be well
Dee.
Another arrogant GP thinking of his budget...change your GP or demand a referral. If no joy from him you can complain to the practice manager. GPs are nothing but referral jockeys and some of them don't even do that! Take someone with you for your next appointment for support.
I've just had an internet trawl on the, 'GP won't refer me', subject and amongst the advice found is; to take someone with you(already said above), tell the GP you want an entry in your notes stating you are asking to be referred, ask for a second opinion(legal entitlement).
Unfortunately it seems your 'right' to referral is down to whether your GP thinks you need to be or not.
Does this GP even have an ECG machine at his surgery? If not, and he has no evidence of his own to go on, that's even more incompetent of him.
Not that a routine ECG will neccessarily pick up anything as the numerous ones I've had over the years didn't pick anything up for me (only the eventual paramedic one and my subsequent Alivecor recordings).
If you have any scares and changes with your heart, any, take yourself to A&E instead of this GP and lay it on a bit, (remember, people go to A&E with coughs and rashes etc!).
Like Loo, the more dealings I have with GPs for myself and my family, the more I realise(the GPs I see, anyway)they don't know anything in depth, only useful for chest/throat/eye infections and antibiotics, repeat prescriptions for inhalers etc and referrals .
My GPs are rubbish but I've never had trouble being referred thankfully.
Good luck.
Try making an 'urgent' appointment when you know your GP won't be available. They can be blinkered because they think they know you well. I could ramble on for ages about situations where a 'new face' has picked up a serious condition the regular doc has missed, also a temp/trainee does not want to be blamed for carelessness (if that is who you see) but try to avoid the old doc who is retiring soon!
Lots of good advice already. I would also e mail or phone and ask to speak to practice manager. Explain your concerns if you are happy to do so and ask for a copy of their complaints procedure and the address and phone number of the CCG. PALS at your local hospital will also help if the above fail (google PALS NHS)
I know it's hard to be assertive but if you don't look after your health no one else will sadly. Best wishes Wendy B
Thank you all for your kind help xx
Just on the Sotalol point. Since I switched from Bisoprolol to Sotalol the frequency of episodes has reduced dramatically, just three in the last four months. I have just reread the NICE guidance and it is clear that it not recommended for rate control alone, presumably because it has an anti-arrhythmic effect, which is not going to help with persistent AF. However, in the case of rhythm control, I see that it is not recommended as a first line of treatment. As I understand it, this does not mean that it cannot and should not be considered when the first line treatments are ineffective. I hope hat I am correct in my reading of the guidelines, but would appreciate any comment.
I am not sure, I appreciate what you mean it's not easy to get the full gist of there meaning of not using Sotalol . I am not sure why either of there sudden dislike to use it, as I believe it's been tried and tested for many many years. So it will be interesting to find out the reason why they are now suddenly reluctant to use.
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