Following up on my ECG posts

Hi guys and gals,

Some of you may remember I posted on here some ECG's late last week.

Well, I followed this through with a meeting with my GP yesterday. Sadly though 'Sods Law' took over and my Printer died on Sunday evening removing the possibility of taking with me printed copies of the more significant ECG's.

I took what I had, along with the device itself, along with my request for an Echocardiogram ....... slammed into a brick wall. She gave the printouts a cursory glance, mentioned something about 10 minutes ( well we know what that's about), commented that she thought there was too much 'electrical interference' to make sense of the ECG's and decided that she'd order blood tests and an ECG.

The worrying thing was that she was so dismissive - yep, I can see her point about the ECG, lets face it anything other than a 12 lead ECG is viewed with an element of suspicion, however, I reminded her of the HR of 149 ... she just put the printout aside. She did run the stethascope over me front and back and pronounced I was fine BUT I would have been cheered a bit more if she'd at least felt my pulse ... got the choice of two wrists ....

OK ...... so I commented that's fine, no problemo, I'll try and manufacture an AF event to coincide with the ECG. Maybe the night before, or several nights before, I'll have to eat all the forbidden food and fruit and try and manufacture an AF event for 09.00 hrs 17 June. She missed the subtlety of it all.

I tried to explain that my original diagnosis was paroxysmal AF, and at times I could be asymptomatic, (but her eyes glazed over) and that this was 9 and half years ago. In that time I have controlled my AF with food/diet and medication and maintaining a reasonable level of activity and am still working but I want a reassurance that these latest events aren't the forerunner/shape of things to come which I want to get on top of. Got nowhere.

My new GP is a young woman, say mid 30's, ( I'm not good on womens ages, always gets me into trouble) a bit superior, (comes across like Anna Soubry the politican) and she took over from a male GP who retired and was more like Doc Martin ..... he and I got on brilliantly.

I suppose, living in Cornwall, I'll have to take an hours drive to Port Isaac and hunt down Doc. Martin. I know exactly where his cottage is.

Anyway, guys and gals, rant nearly over.

Can anyone reading this in UK advise me on how to go about organising/getting an Echocardiogram done privately and paying for it myself.

Rant officially over ... till the next time. Grrrrr !

John

[CDreamer]

Morning John. Firstly it sounds as though you are quite concerned and really want to be taken seriously and I can relate to feeling very frustrated when I believe I’m not listened to or taken seriously. Is there another GP at the practice you could see? Having said that, I’m not sure, however, that GPs are the ones to reassure about AF and I always now go to the EP or ask to be referred.

Secondly - I discovered that many younger GP’s in my practice really don’t know in enough detail of how to read an ECG and tend to refer to cardiologists anyway, which surprised me as, like you my long time Doc Martin type GP - must be something about the SW - retired. He was a heart man and just really interested. I was assigned to a younger, female GP knew little about hearts but a lot about Mg as she had managed Mg patients before whereas my previous GP had never, ever seen a case in his life.

I asked the same thing recently - to have an ECG because I know they have several machines in the surgery and was told in an emergency go to A&E as they will only send the traces through to there anyway and so now my husband & I send ECG traces directly through to our own EP and he advises through letter. The trouble is that unless you were in AF there and then and if she used a stethoscope then she would have picked it up, what would be the point?

Although I took some time to get used to my new GP and I probably don’t have the relationship I had with my previous GP - when I have really need her - wham - she has been there and immediately, no messing. I found also that the ‘new’ breed are much better at monitoring generally but tend to do it remotely through tests and computers - not because they WANT to, but because that is how the service is going. And there really is a very strict 10 minute rule - which stresses the GPs as much, if not more than us patients. It’s now the Practice Nurses who do the ECGs. I know a few of our GPs socially and I can tell you that none of them work full time as a GP as they find it far too pressured. Most have second jobs - mine works as an A&E doctor 2 days a week, another lectures at the medical school, another has a private practice in a speciality. That is just the way of the world I’m afraid.

One of the new initiatives our surgery has changed is that I now see the same nurse every 4-5 weeks for blood draws and she will always flag up something I say or something she notices so I now feel well monitored and I think that is really what we all want reassurance about.

Change is always difficult, GP surgeries are closing at an alarming rate and GP’s are pushed to the limit so my suggestion is deep breaths and give the woman a chance before changing to another practice as there is no guarantee you will be served any differently anywhere else.

Best wishes CD

[Hidden in reply to CDreamer]

Hi there CD,

Thanks for your comments, and to everyone else too. Very kind of you all.

I'll comment on your response now bit by bit and it will probably cover comments made by others too.

Its like this .... I'm fortunate in that I have a 'challenging mind set', am reasonably articulate and don't suffer fools or bureaucracy gladly. Its now 9 and half years since I was diagnosed and I have managed my own condition more by myself than through my GP. There are 2 elements medication and diet/food and I am satisfied that I'm doing the best I can with these two. Yet there is a third element - the actual condition of the heart. I know, a gut feeling, it is not functioning efficently. An Echocardiogram will provide the evidence of this as its all about structure and mechanical issues rather than heart electrics.

In the last 18 months I have become aware that in a general sense my cardiac condition appears to be deteriorating, in other words undesirable cardiac events seem to be becoming more frequent.

Yes it is a largish practice with a number of GP's and yes it maybe that I'll have to see another GP within the practice but if I do it'll be with one of the senior partners in the practice. My planned blood tests and ECG will take place within the practice by one of the practice nurses. In effect I don't want an ECG I want an Echo and I made this quite clear to the GP and why ... all fully explained.

Had the damn printer not died and I had more stuff with me this outcome may have been different.

Yes, I agree .... practices are different now compared to when I was first diagnosed. I wonder what this GP would do today if I presented with evidence of falling blood pressure, which bottomed out at 76/49 with a rising HR.

It all changed when Practices became financially responsible and accountable for the activities of their own business unit. Which was what the government of the day wanted. Out the door went personal healthcare and individual attention and in came a production line with 10 minute time slots.

I am sure my GP works at other healthcare activities too, because whenever I try and get an appointment that suits me ( because I am working) she is never available. And whenever I've tried to make an appointment online I haven't been able to. Its the fact that practices are closing so frequently that is ever so subtly creating an environment whereby each of us is going to have to become so much more skilled at managing our own wellbeing. Its becoming a wicked world ..... the bus I drive runs through the housing estate where my GP's practice is and many of my passengers are patients at the same surgery. Given their socio-economic grouping how they manage to tell a GP what's wrong and have a meaningful consultation all in 10 minutes when most can hardly put their bus pass on the bus ticket machine reader defies all logic.

So at the moment as its only 12 days till the tests I'll fall in line and see the results. I'm fine with that as it gives me more opportunity to amass evidence as to why I still want the Echo.

Yep, CD ... I'll give her a chance - but only one !

bless,

John

[CDreamer in reply to Hidden]

Good for you John, need to be feisty with these GPs. I would always trust your intuition over any doctor so do hope you get the Echo sooner rather than later.

I am beyond myself with the state of appointment times, you are quite right but unfortunately - that’s what we are left with.

[jeanjeannie50]

Hi John, is she the only GP at your surgery? If not I think I'd try and see someone else next time!

Did you mean to ask about getting an echo-cardiogram done privately, or did you mean ECG? My doctors surgery has it's own ECG machine, does yours? The 17th June isn't that far away and why didn't you ask her to take your pulse if that's what you wanted. Though listening through the stethoscope would have told her what your heart was doing more than feeling your wrist.

I had a private echocardiogram a long time ago when my AF first started 14 years ago. I guess if you approached any private clinic they would give you a price. Not only did I have to pay for that scan, but also for someone to look at it and give an opinion on what it showed. I'm afraid I can't remember the cost, could have been £100 or £200.

Good luck, I hope you get yourself sorted.

Jean

[Hidden in reply to jeanjeannie50]

Hi Jean,

I did explain to her the issues and asked about the chance of an Echo (NOT ECG) and explained why. I guess what annoyed me was her dismissive attitude. Plus not even a BP check - bear in mind it was falling BP originally that got my GP back in the day, to get me into A & E so promptly. As I say all this was explained. OK I can understand no wrist check when she'd done the stethascope check .... but no BP.

I think its all about process these days NOT care. Hey ho ... lets tick a box that'll sort it. Its a health service which isn't about care but box ticking.

No I meant an Echo done privately. If all else fails then that's what I'll go for and I'll be starting making enquiries soon.

Thanks for your comments Jean.

john

[BobD Volunteer]

It just goes to show how different surgeries can be. Years ago when things were bad I had an arrangemnet that i could ring up and then appear at the treatment suite and one of the nurses would do a 12 lead ECG. copies of which I could e mail to me EP. This meant that so long as any event lasted more than say an hour I could have the trace with my EP within that time. I know that one or two other members managed to set this up with their surgeries as well but it was probably ten or twelve years ago.

I do agree that few GPs these days actually understadn ECG traces and for that matter a number of hospital doctors often get it wrong. I watched a tutorial a few years ago where an ECG specialist gave a room full of doctors various traces to examine and diagnose and over half were way off. Always make sure that copies of any test results are given to you and keep a file. Mine is about 2inches thick!

[Hidden in reply to BobD]

Many thanks Bob, especially for the advice of getting copies of test results. I hadn't thought about that but now you've mentioned it I can well appreciate the logic.

Your comments about understanding and interpreting ECG's is something of a worry.

John

[Hidden in reply to Hidden]

My GP's surgery will not have an ECG machine as no one there is qualified to read the ECG's

However,they do have a couple of Kardia devices that they loan out as they find these very useful

[Buffafly]

Hi, I had a similar experience though my GP didn't even offer an ECG, she just said 'Why don't you send the recordings to your cardiologist if you think he'd be interested - I don't know anything about heart problems'. I was very reassured...... Problem is I don't have 'my cardiologist' as every time I am discharged I seem to see a different one next time 😕

[Buffafly in reply to Buffafly]

PS I think a call to your local private hospital would probably sort out the echo problem.

[Hidden in reply to Buffafly]

Hi Buffafly,

Thanks for that.

No I don't have 'My Cardiologist' any more either. If push came to shove now, I'd need to start again either being admitted to hospital through Paramedics and A & E or getting a referral from my GP.

John

[Finvola]

That GP doesn’t grasp the basics of PAF and was horribly dismissive. I agree there was interference in the trace but does she imagine you are making it all up? Definitely see a different GP - somehow.

Regarding private diagnostics, your local hospital may have a private section which will give prices, or, failing that, a private clinic. You will need to inquire if they accept requests for diagnostic tests without referral from a physician (referrals make more dosh!) and then you’ll need a competent physician to interpret the results.

It might be worth thinking about seeing a cardiologist for a proper discussion and evaluation of your traces (fix the printer!).

Best wishes - my teeth are gnashing for you.

[Hidden in reply to Finvola]

Many thanks Finvola,

The great thing about everyone's replies is that it has stopped me from getting into a particular mindset, of being anti GP ! Its made me look at the wider picture and become a little more rational in my approach to problem solving. Your comments about private diagnostics cover things that I'd not even thought about.

I'll post a summary of the outcome when I've had my tests on 17 June.

John

[jedimasterlincoln]

How annoying!

The trouble is, a radial pulse is so far from the heart that it wouldn’t be particularly useful to her at that point – not given the demeanour you’d experienced from her at least!

I have been in the situation with ECGs and other assessments missing events, primarily last year when my resting HR was 120 rising to 190 on climbing a flight of stairs and me insisting this wasn’t normal, yet whenever someone came to assess or measure it I had been stationary or in bed for over an hour so there was no presentation of the cold clammy sweats the breathlessness and dizziness. I not so subtly suggested they should come back in 10 minutes when I’ve walked around my bed space a few times and they relented.

You need a second opinion.

[Hidden in reply to jedimasterlincoln]

Hi there Jedimaster,

Yes, balancing out everybody's comments I need to come up with an alternative approach when I've had the tests and got the results.

Unless I have the misfortune/good fortune to be in AF when they do the ECG I know exactly what it'll show .... much the same as your experience. Damn all !

May the force be with you.

john