I received the following letter from a consultant-addressed to my GP- following my aborted angiogram of last week. It’s fair to say that since I read it this morning I have had steam coming out of my ears, not to mention chest pains. I would value any feedback and advice how to proceed:
“Mr [..] has twice now attended for invasive coronary angiography and due to his ongoing anxieties and multiple questions it [sic] has not proceeded”.
In fact, on the first occasion the angiogram had not gone ahead because I had not paused Apixaban. On the second occasion, I was told I could not have a sedative which was a primary reason for the decision not to go ahead.
The letter continues: “ I think therefore that we are not going to be able to offer him suitable investigation and my wisest way forwards for him would be to presume he does have coronary disease in view of the echocardiogram and ECG findings and treat him accordingly with primary prevention medications including the Apixaban he is already taking. I would suggest he is switched from his use of Sotalol to Bisoprolol 5mg once daily.”
First of all, the hospital obviously *could* offer another procedure with sedation if it wanted to. And it seems absurd to say that you cannot have a procedure because of anxiety and asking multiple questions. To ask someone to presume they have a condition when they may not seems potentially dangerous. I certainly wouldn’t want to risk switching from Sotalol to Bisoprolol without having a proper diagnosis and an explanation of why it was necessary, particularly as the Sotalol is working well at the moment. The consultant has not given me any feedback on the abnormal angiogram which was taken on the day. I wondered what anyone thinks of this letter. The most immediate worry is that the GP could switch me to Bisoprolol on the recommendation of the consultant. Can I insist they continue with the old medication? What are the problems with Bisoprolol, if any? Can I insist on being referred to another hospital?
That's terrible. Isn't there someone at the hospital or facility in a supervisory position you can speak to?
Here in the states, If it's hospital-based. We have something called a patient's advocate you can go to resolve situations like this. But maybe going to another hospital is a better option.
I thought angiograms were normally performed under sedation? But if not, certainly sounds like a reasonable request.
Thanks. There is an organisation called PALS who act as advocates for patients- they are based within the hospital and try to resolve issues within five days. As it’s the weekend I won’t be able to contact them until Monday. Alternatively, I could make a more formal complaint which might take up to 28 days to resolve.
I hope so too. I’m not a vindictive person but I’m absolutely livid about this. Going to a private provider might be necessary, but I don’t feel it should be necessary.
Sotalol is not used much nowadays and bisoprolol is considered safer but some people feel tired on it and there are alternatives. I would ask to be referred elsewhere for an angiogram and I wouldn’t trouble to have sedation as the procedure is easy and painless I asked them to move the screens bit so i could see mine
I’ve taken Sotalol for around 4 years and haven’t had any PAF for 6 months, so you can understand why I’m reluctant to switch. I would only be willing to do so if I thought there was a good medical reason to do so. I don’t consider being denied an angiogram in account being anxious and asking multiple questions to be such a reason. Of course, it may be difficult to persuade the GP to continue to prescribe Sotalol given the consultant recommendation.
HiI would take it to be two separate issues I e he knows Sotalol has serious issues so wants you on something safer( issue1). Couldn’t do angiogram as felt you were too nervous( issue two). My bp was very high when I had my angiogram and they waited for it to settle. Might have thought risky if you appeared very stressed?
They said my BP was ok to do the procedure. They were willing to do it, so they couldn't have thought I was too stressed. They were willing to do it without sedation. Nothing has been said about Sotalol being dangerous to me. If the consultant thought that he should have said so, i.e. explained his reasoning.
Perhaps you should consider having it without sedation if you feel you can. I found it fine. You can research Sotalol so you can make an informed decision. Some doctors still use it but because some issues came up they try other things. I don’t think they want to cause alarm - even side effects of paracetamol look scary if you read the packaging!
What result are you wanting from your complaint? I’ve been told when complaining about service in retail etc you should state clearly what redress you consider appropriate (otherwise they fob you off with as little as possible, as I found when PetsAtHome nearly killed my cat with a dangerous toy 🙁).
I want to be offered a further procedure, the proposed change of prescription stopped (at least until it's evident it's needed) and some feedback on the abnormal ecg of last week (so far I've had none).
Hi SI found a astute Auckland Cardiac Specialist 'wanting' as well.
1) He put in his report x 3 times that although PRADAXA 110mg(anti co-agulAnt x 2 day) was one of my prescribed meds since a stroke, he did not believe I was taking it.
I was but the March prescription was not registered so he only had the January one showing. A 3-mth prescription.
To date I got more in july.
I tracked through my Chemist for a copy of my March prescription. All in order.
I wasn't allowed to take it before and after my operation at a different hospital for Mesh Removal (J&J) in March.
Now I have the evidence I will send it to him.
But why didn't he believe me.
2. After the stroke with AF the Dr talked about what she was going to prescribe. Mentioning Metroprolol I said no it will make me breathless. She overrode me and I suffered for 1 year 4 months on it. I had a day avg rate of 186. No energy and was fatigued. Changed to Bisoprolol but the breathless left only reduced heart rate to 156. As you know CCB Calcium. Channel. Blocker Diltiazem 120mg Controlled at 77-88 Day staying 47 night but stayed but separating to night 2.5mg Bisoprolol.
3. A direction from Dr (Encrinologist) on the Stroke Ward to wait 6 monthe before the thyroidectomy for cancer. But the surgeon and anaesthetist said now which got to 4 months. Done the result showed it down 2 lymph nodes.
4. Although after thyroidectomy RAI RADIO ACTIVE IODINE infusion is given but I declined. Then I gave up on suppression which was leading me to toxity of thyroxine the synthetic hormone med.
2 years later a direction for LOW RISK patients was "it is unnecessary for these patients to go through RAI treatment. And suppression is unnecessary as well.
2 neck scans now and no cancer return .
5. I believe it is important to ask Dr to refer youwith AF to a speciast person. Drs seem to push dosage up and not explore other meds like CCB.
cheri JOY. 73. (NZ)
you have a right to ask ?s but in the pre-op rather than near the date of operation.
The only option is to find another consultant who treats patients like human beings not statistical annoyances! I very much sympathise having seen a French cardiologist fairly recently who refused to discuss my condition with me as he 'didn't have time' and refused at first to even tell me the name and type of drug he wanted me to replace Sotalol with, having said, 'We don't use THAT any more!' In fact like you, Sotalol works very well with me and nobody has yet explained to me why the replacement (which I discovered was Nebivolol.. of which I had never heard) would be any better. In fact he more or less insisted my only option was an ablation (which he didn't 'have time' to discuss with me either) and that either drug would leave me in permanent AF. (And ablation has a low success rate with those in permanent AF for some time). Thankfully I continue to cope relatively well with Sotalol and regular exercise but if my condition worsens again I will definitely seek out a cardiologist who is recommended and pay what it takes. After all, these decisions are about our lives and our survival not keeping some ignorant rude consultant happy.
Sorry to hear that you have also had such a negative experience. Ultimately, as you say, I will probably have to see another consultant. Another concerning aspect of this is that no doctor has actually told me that I have CHD; instead a letter from one consultant to another states that he is going to "presume" that I have it. This isn't a good way to convey information to a patient.
At least he did not cut short the appointment by telling you he could not understand your accent! This happened to me at a consultation with an anaesthetist because I was querying ( after my surgeon had told me to do so) what antibiotic would be used presurgery.
Yes especially as I am often mistaken for a Frenchwoman and asked what part of France I come from ( they know I have an accent but mistake it for a French regional one and often assume Alsace as I have a German surname). I think you have been treated very shabbily . I would have thought such a procedure requires you to keep still and be relaxed.
I was given 50mg of Benadryl which is used for allergies since I'm allergic to the contrast used for many of these procedures. Didn't knock me out but I was pretty relaxed.
Actually that was partly what MY consultant used as an excuse not to talk to me! I have/had good French as I became a citizen three or four years ago, but my consultant was not from metropolitan France and had a strong accent, and proceeded to abuse ME when I couldn't understand him, and said I had never bothered to learn French! In fact, having had a stroke which affected my speech just two years ago, I have more difficulties than I once did especially in recalling words, but his behaviour towards me was disgraceful. I suspect it was inverted racism. He left me in a state of near collapse with my BP up to 180 over 100! Such people should not work in medical services anywhere.
I hasten to add that this is NOT typical of the French health service where I have found up to that point wonderful care and doctors who are understanding and do all they can to help the patient. I have considered making a complaint but in the end did not think it worthwhile to do so.
Snap. My anaesthetist was a Magrébin and a nasty piece of work. My cardiologist had supplied me with a letter saying that 3 days was plenty time to be off Apixaban before my hip op. This was my second hip op and before the first they took me off for 8 days and prescribed bridging Lovenox twice a day which meant getting up at the crack of dawn for the nurse as I was always first on her round. By the time I got into the clinic my stomach was one huge black bruise. When I gave him the letter he nodded in agreement but after the nonsense over "my" accent he whispered in the ear of the secretary while giving me a dirty look. She then told me I was to come off the Apixaban for 4 days! I ignored this and followed my cardiologists advice. There was no need for him to extend the time and in doing so he was putting me at risk. I did not complain either - just hoped that on the day he would not actually be the anaesthetist for my op.
Last time I was in the hospital I had a foreign Dr. As I stated in another post here we are getting a lot of foreign Drs coming here to the USA. (No one wants to be a Dr these days). He was very arrogant and talked too fast. Never looked at me. Just the floor. He wanted me to do a nuclear stress test which I declined because of the chemicals they use are too harsh for me. I explained to him I'm one of those whose system just does not tolerate drugs well. So he said-Well if something went wrong we have drugs to fix that. It's like he didn't hear a word I said. I said no nuclear stress test. He wouldn't allow the treadmill test. He told me we don't want to be responsible if you fall and break a hip. ???? I said any time I've done a stress test there was an aide on both sides of me plus there are bars attached to the treadmill to hold on to. Guess he didn't hear that either. He asked me if I ran on the treadmill. I said no. I didn't need to. I did when I was much younger but seldom do you run if you're elderly. And truth is you don't have to run to achieve desired results. Anyway that Dr put in my discharge papers that I was noncompliant. It should have said patient declined the stress test and included the reason why. Yes he was arrogant and rude and thought he could do whatever he wanted to me. Without consulting with me first earlier in the day. He thought he could just come in before he wanted me to go down for the test. Nope. You are supposed to consult with the patient first to get the patients okay. And to explain things. He had me discharged pronto. When I followed up with my cardio Dr she asked why he wanted a stress test? She said for what I was in there for I didn't need the stress test. She was a little bit put off by him. She's the one Dr I have that is pretty decent. Where has good medicine gone to??
Good luck with getting the matter fixed and finding someone who can give you good advice and a proper hearing. I am sure you are acquainted by the likes of Dr Sanjay Gupta on Youtube (York Cardiology) as people like him might be able to point you in the right direction to get a sympathetic and informed opinion about what is best to do.
My wife had a CT Angiogram...far less invasive. The normal angiogram was ruled out as they were worried it might trigger her PAF. Waiting time was long so we paid to have it performed privately at our NHS hospital.
This is very interesting. When I asked the consultant why I could not have a CT scan instead of an angiogram he said that it was a less accurate test and might yield a false positive. He also said "and it would not be accurate enough for somebody with PAF." This appears to be the exact opposite of what you were told. Furthermore, I raised a concern about the invasive angiogram triggering PAF which he was dismissive of. Obviously, both of these consultants cannot be correct!
I had to have an angiogram as I'm waiting for valve repair surgery but I requested the CT one and my surgeon obliged, on the proviso that, if there was any ambiguity or anomaly with the results, I'd have to have the invasive one. It took 2 months for the appointment to come through but I guess that depends on which hospital you are at.
The wait for an invasive angiogram where I live is two months (its one of the shortest waiting times) whereas the waiting time for a scan is 4 months. I suspect that this is one of the reason they are putting people forward for invasive angiograms and not offering CT scans.
That's exactly my view as well. I was offered the CT by a specialist nurse on initial consultation but this was overuled by the consultant who proposed the invasive angiogram instead. When I asked the consultant about this he said that the CT wouldn't be appropriate for somebody with AF, but this is contradicted by many here, including yourself, who have been offered CT scans.
I've been in NSR since April following a cardioversion, so whether that makes a difference, I don't know. Also, he said he's not expecting to find any coronary artery disease I just had to have one prior to surgery as that's their protocol.
Phew. I have steam coming out of my ears on your behalf. How dismissive and patronising can you get! Seems you are demonised for questioning anything nowadays. Also is it an excuse for saving money by not doing procedures.Anyway I would be horrified if I was taken off Sotalol and put on bisoprolol as the latter drug really ruined my quality of life. I would hope that the GP would take into account my feelings and discuss the matter with me, which it doesn't appear the consultant is prepared to do.
Yes. If try to discuss anything with the Drs I see they don't listen. Let alone look at me. I just had a friend go see a specialist about a possible thyroid problem and she had the same experience. She said the Dr never looked at her in the face once. Never talked to her about anything. The Dr stared at her computer the whole time. I remember when you could talk to the Dr and the Dr was happy to hear what you had to say. Now all they do is ask your symptoms and throw some pills at you and say see you in 3 months. I wonder why I even bother to go to the Dr sometimes. 😞
Hi Belindalore. I totally agree. I just don't bother to see my GP any more. In fact I don't see anyone and cope on my own. I'm in AF at the moment but can see why. We are having a fairly strong solar storm from a coronal hole on the sun which emits a stream of charged particles. That always kicks me off. I monitor space weather as I know it links to my episodes. There have been papers written on how the earth/sun magnetic field connection can affect the human body and the heart. There's more to us humans than is realised.🤔
So true. Since the hot weather my BP and HR are all over the place. I agree we don't realize how much the weather and other outside influences affect our bodies like what you discussed.
I'm saddened by your experience but not in the least bit surprised. All of the letters sent to my GFP from hospital doctors after procedures or consultations have, at best, only been about 50% accurate in terms of what was said or done at he consultation.
As suggested by another reply, you should take your problem to PALS, I've found them to be sympathetic and helpful but it can take a couple of months to get an issue resolved. In my case, I made a formal complaint about the attitude of a consultant on my very first telephone consultation with him due to his arrogance, dismissive comments and unwillingness to answer any of my questions. One question in particular prompted the answer "It's too complicated for you to understand. My response of "try me, I might be more intelligent than you obviously think I am" didn't go down too well with him either. I did, at least, get an apology from him eventually, which did help but not by much.
It's incredibly patronising to say that to a patient. In general this sort of thing seems to be more prevalent from consultants than GPs perhaps because they are in more regular contact with a given patient. I've drafted a letter to PALs as several people have suggested. I've also been advised by a friend whose brother is a doctor that a reference to CQC (the inspectorate) is likely to get their intention.
The questions about medication should be answered by someone with pharmaceutical training. Is there a pharmacist within your GP surgery that you could ask?
You can ask for a referal to a different consultant, but you would go to the end of another waiting list so it may be a long wait. If you need to see someone sooner or feel that you need more than the usual NHS allocated appointment time you could have a private referal.
Finally, we all need to remember that the best time for questions is at the clinic appointment with a consultant or registrar. The consultant's secretary is usually able to pass on any other queries that arise between a clinic appointment and a procedure.
On the day of a procedure the technicians are busy setting up complex equipment in a timely manner. They are very skilled in their own field but are not able to answer the medical questions which should be for the medical team. They should of course explain the procedure clearly and adhere to the consultant's instructions, for example if sedation has been agreed with the patient.
Also all medical professionals (and patients) should talk clearly and repeat something if asked respectfully.
I hope you can get this resolved and get your procedure soon.
I totally agree with your comments about the right time to ask questions. But I have never met the consultant-I saw a specialist nurse who proposed a CT. On the way home she rang to say the consultant favoured an angiogram. So I had no opportunity to discuss the angiogram. Later I got to speak to a consultant on the phone at my request but it was only about 10-15 mins. At the pre-assessment I was told to ask questions on the day of the procedure. I said this wasn't ideal because the doctor would be getting ready to carry out the procedure, I would have limited time to make a decision etc. .
I rang CQC today and got a good response from them. An inspector range me back after an initial call. They stressed that they couldn't investigate compliments but said that the hospitals response could "reasonably be described as rude" and made various other comments - they said they would raise the issue at their monthly meeting. They suggested speaking to the GP and PALS for a way forward.
Sounds like the Dr hasn't read your files on why you didn't have procedure done. And also did not discuss anything with you before you received the letter. That sounds a little like neglect on the Drs part. And to presume that you have something IS dangerous. If you still want to have the procedure I'd insist on it. Maybe go somewhere else if you can. And why change your meds if what you are taking is doing fine for you? Stand your ground. Drs aren't always right.
I should think most people are anxious before a hospital procedure and surely it is sensible to ask questions about any concerns you have. Is there a complaints department at the hospital you went to? There usually is someone (PALS at the hospital I attend) you can contact in the first instance. I wouldn't let it go. There is no need for you to have received a letter like that. Ask for another opinion if needs be. Good luck with it all.
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