So, many months back my GP swapped me from the originally prescribed Lansoprazole to Omeprazole (PPI's) due to my having the raging squits and other stomach problems. After my "annual review" a couple of months ago another GP couldn't decipher the cardiologists hospital notes so had to write to him to determine which, if either, of the 2 anti-platelet drugs should be stopped after the year. Cardiologist comes back with Stay on Clopidogrel and stop the Aspirin, no mention of the Omeprazole. So, I get my research head on and discover via the NHS website and BHF nurse that Omeprazole is not supposed to be prescribed with Clopidogrel as it can increase the effectiveness of Clopidogrel and lead to possible bleeding issues. After speaking to one of the better GP's at the surgery he agreed and has now taken me off Omeprazole altogether, apparently they are only really an insurance policy in case you develop a stomach ulcer, so basically you are possibly taking an unnecessary drug. I know a couple of other guys who were never prescribed them in the first place. So, the thing is, why is a cardiologist advising to stay on Clopidogrel when they are not recommended together without pointing out the clash with the PPI?? Obvious answer is that my notes are not being updated, or read, or both. You could also ask the question as to why I or anyone is given a PPI along with Clopidogrel in the first place? I have to say it doesn't inspire me with much confidence. My advice to anyone would be to check and question everything, as whatever system is in place is not too great in my experience to say the least.
Notes, what notes?: So, many months... - British Heart Fou...
Notes, what notes?
Now you understand why I have referred to my notes in various posts as " a work of fiction."
Reading your post once again made my stomach churn - reminded me of the three days i spent on Omeprazole in the toilet. I point blank refused the Lansoprazole which i was told to take instead when I discovered it was being prescribed as a "precaution". When I explained to the Registrar some months later why I wasn;t taking the PPI he said he fully understood and there was no need for it. It;s all bonkers - I have even been told I don;t have a stent and I didn;t have a heart attack as it "is not in the notes"...... don;t get me started. I find it all ludicrous and having to be assertive whilst feeling awful is guaranteed to make me feel even worse. I have no idea how you beat the system of poor or non existent records - my husband brings in the letters from the consultant as even he realised things had gone too far after being told I was "elderly and confused". I have no confidence in even the handed in notes being read. Thanks for letting me rant.
Oh don't get me going......rant warning everyone from me too.
I went to see my GP after my latest 10 day stay in hospital.
His comment was 'what went wrong ?'
Followed by ' your discharge summary is a Fairy story!!'
Me ' well they didn't read or follow my admission plan'
GP's response a big sigh and eyes rolling to heaven👀😳
I have an admission protocol approved by the Head of Cardiology only problem somehow the staff can't quite understand that they are not only meant to read it that they should follow the very clear management plan.
I now usually say things like please can you document the following in my notes.....
I absolutely share your frustrations a cultural shift is required. As patients some of us are the experts in the room about our especially less common heart conditions.
The trouble is, it is easy to criticise, however I cannot help thinking that things could be so much better. The initial treatment I had was fantastic, and I feel very grateful that I have been almost literally given a second life, as I know I could have been so much worse off or even not here. But, these problems are not really medical but administration faults. If a Doctor has to contact the cardiologist regarding medication, it is going to be via email these days, so why cannot the patient be copied in? We are allowed full access to our records anyway. It is inexcusable that the cardiologists reply has just sat there and nobody has thought to pass the information on. The problem, as we all know, is down to resources, but if things were thought through it wouldn't even need anyone to do anything! Given the advances in medicine, if the same advances had been made in administration think how wonderful it could be.
I agree.
It isn't rocket science.
I have both of my Cardiologists , GP and other healthcare professionals responsible for my care emails.
There is absolutely no decision without me.
I have had wonderful care too which made my latest hospital admission even more frustrating.
I am on Clopidogrel and Ranatidine, I was on Clopidogrel and Omeprazole, but the pharmacist rang me up and changed me to Ranatidine saying, Omeprazole negated the the effect of Clopidogrel.
Aspirin was the second drug that made me ill with colitis, the third drug a statin.
I'm not sure whether the problem is administration or medical related. What makes the difference is the individual person and how motivated they are to do the absolute best for the patient. Of course it doesn't help if everybody is stretched to the limit and stressed beyond reasonable levels or best practice processes are not in place. Then no-one can do their best.
I wouldn't assume that all information is passed via email. During my backwards and forwards period last year for testing etc I was surprised how much was done by snail mail.
But I am a big advocate of the administration improvement that joined up medical records would bring in this day and age. The consultant at the hospital put me on a course of medication with no idea about my medical history or anything. I couldn't help as I was too stressed even to remember my last blood pressure reading.
Hi Lateguitarist
The Cardiologist took me off Clopidogrel and put me on Apixaban instead. He said it's better medication along with other medication he prescribed too. I've got coronary heart disease, significant heart failure, unstable angina, paroxysmal atrial fibrillation, leaking mytral valve. The Cardiologist said he is training my heart with the medication. I never get any information sent to me from consultants. I have to ask the GP if there is any information I want to know. I've told him before it's my body and I want to know what's going on. I do hope you start to feel better soon.
Why don't you ask to be copied in to letters from your consultant to your GP?
Apixaban is used for atrial fibrillation, but clopidogrel for stents.
I didn't know I could do that. I'm waiting on another appointment with the cardiologist so will ask to be copied into letters from him. Ok Clopidogrel isn't for atrial fibrillation. I live and learn. Thank you.
Doesn't inspire confidence, does it? Weren't we always told that the computer was going to solve all our problems - not just medical - and wasn't it going to make it easier for doctors and consultants to refer to a patient's notes? I've lost count of how many cases I have heard to the contrary.
It has helped a lot - e.g. digital X rays are almost instantly available on the computer etc.
Unfortunately when the NHS suggested having a system by which patients' notes could be accessed from any part of the NHS there was an outcry.
Really who from?
The public!!
Lots of people signed petitions against it. The worry was about data protection.
It would have been extremely useful for those who end up as emergencies in a hospital where they were not normally a patient.
It's possible the GP wrote to the cardiologist about the anti-platelets without mentioning the change in PPI - or of course he might have been stopping the aspirin because clopidogrel doesn't irritate the stomach and so wouldn't need a PPI!
Email isn't actually used that much as it's seen as less secure. I found it frustrating when it took a month for a referral to go from consultant to surgeon in the same hospital!
Discharge notes are done by junior doctors who often haven't been involved in your care. I agree they can be a bit ropy.
Aspirin does cause gastric bleeds hence the precautionary PPI. Not my favourite drug, but I couldn't take aspirin without it. The GP should have known about omeprasole though, but these sorts of errors can creep in when GPs change medications initiated in hospital.
This is just typical of why we have problems. Reading your outlining of what might or might not have gone wrong is probably very accurate. The answer is to make sure that all these people share a common database, and update it, it is not rocket science, and these are supposed to be professionals. It makes you wonder if they can't get something as simple as my little problem right what else they are cocking up. Why should a system not be used just because people "don't like it?" Sounds pretty good to me, we listen far too much to these "human rights" types. There is one in particular that drives me mad, I am sure you all know who I mean.
I'm afraid my feeling is that whatever the system mistakes creep in - as in virtually every human situation! Thankfully most are minor.
The GP, as the person who knows all the medications you were on, should really have checked interactions - I think a lot of GP computer systems flag these up. I'm surprised the patient insert didn't mention it.
A second check from the pharmacist, as happened with Rosei, is helpful.
To be honest I do not understand why I was ever put on either of these PPI's due to being on Clopidogrel from day 1. If it's not OK now it wasn't OK then, obviously. The GP swapped from one to the other, and then decides that the other should not be prescribed along with the original medication, it's mad. It is quite obvious to me now, that the GP's don't even read the notes, and these are some of the better ones. The last one said he was going to swap me onto a PPI that I had already been on and that he himself had taken me off due to side effects! I have now had 3 GP initiated phone calls rather than an appointment and every time they just ring up and say "You booked a phone appointment how can I help you" even if it is for a specific thing such as blood test results. They obviously don't even swat up on your notes before they ring, and then after a few minutes their tone of voice alters and they want to get you off the phone. Basically, they don't have the time to do their job properly. Surely it is not rocket science to have some sort of warning flag that shows up if 2 incompatible drugs are prescribed together in error?? I have now been on 2 anti platelet drugs for more than a year along with a PPI which enhances the effect of one of them and is not recommended alongside one never mind both of them, and to cap it all if I had not taken it upon myself to question things I would probably still be on them, and even then they still manage to cock it up!
The original lansoprasole is fine with clopidogrel and was prescribed to reduce the chance of stomach bleeding with aspirin. It's unfortunate it didn't suit you.
I think there is a flagging system but I expect the problem was the change was made in a hurry with a large pile of other things to do. The lack of time does mean things get skimped, unfortunately, something which is frustrating both for the patient and the GP.
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