Second opinion procedure?

[jerry12953]

Hi,

In July I had a follow up appointment with a cardiologist at my local hospital. About two years since the last one.

She was friendly and efficient but afterwards I felt dissatisfied. She took one BP reading but didn't show me the results. None of the tests I have had so far have shown more than minor blockages in my main arteries - "unlikely to cause any symptoms" I have been told. I mentioned microvascular angina as a possible cause but she ignored that.

A couple of weeks later I had a phone call from "the pharmacist" at my GP surgery. I didn't know they had one and they certainly don't dispense medication there. She had had a letter from the cardio with various recommendations, including upping my dose of statins (why???) and adding more BP medications. I asked for a copy of the letter.

As a result of this I recently wrote to my GP expressing some dissatisfaction with the cardio and asking to be referred upwards to someone more senior. I am still waiting for this to be put in hand but have just had another phone call from the pharmacist. It went to voicemail but I expect she will phone again tomorrow.

What should I say? The least I should expect would be another appointment with my GP first surely?

[Mentdent]

I check my own BP at home using an Omron . Minimises the white coat phenomenon.

[jerry12953 in reply to Mentdent]

Yes, I do the same from time to time and have sent the relevant readings to my Gp surgery.

[Gibson01]

Jerry,From my experience I would suggest that you talk to the pharmacist when he or she calls. GP surgeries seem to be employing them more and more and they have their own set of skills. However I do think that you should receive a copy of the letter from your cardiologist to the GP and discuss the content with your GP. My own experience has been that GPs rarely read and act on the recommendations of consultants without being expedited. The fact that your GP has acted (even via the pharmacist) is good. As for your next cardiologist appointment, be prepared in advance with a list of questions and don't leave until they are answered. I know that is difficult in a pressure situation when you are not feeling well. If it helps, ask to take your partner or a friend along. Two heads are often better than one.

Checking your BP at home is a good idea, particularly if you suspect white coat syndrome. But don't obsess on it. Three times a week in repeatable circumstances is probably sufficient to build up a picture, you will need to record the results over several weeks to see if your bp medication is having and effect. Sometimes different combinations of treatments are needed to reduce your bp and heart rate to the target range.

I hope this helps.

Good luck.

[jerry12953]

Thanks for the helpful reply, Gibson.

I did get a copy of the letter but only when I asked for it. One expects that a cardio will deal with patients professionally but I was not convinced this was the case. Not acknowledging the possibility of microvascular angina seemed to be a major shortcoming and not sending me a letter was another, hence my asking for a second opinion.

If and when that happens I will certainly be more on the ball with questions and asking for answers! I will explain the situation to the pharmacist when she phones again and expect to have another appt with my GP in the near future. I wonder if I should put off any change of medication until after that.

[Qualipop in reply to jerry12953]

I'm afraid since my heart attack I haven't heard a word from the cardiologist. I don't even know who they were. No follow up; even medication problems had to be passed via my GP for advice.

[Retirement65]

Hi Jerry I would just Reiterate what gibson01 has said to you I would end up just repeating same thing but that’s what happens now in general practice lot more stuff is delegated to the appropriate clinician but to be fair they have more time so definitely have all your questions if they are not able to answer they will check with the GP take care hope your sorted soon 😊

[jerry12953 in reply to Retirement65]

Yes, your point about the pharmacist having more time is a good one.

[Milkfairy Heart Star]

"Not acknowledging the possibility of microvascular angina seemed to be a major shortcoming and not sending me a letter was another, hence my asking for a second opinion"

In England you should automatically be sent a copy of the Cardiologists's letter to your GP.

I suggest you ask your GP to refer you to a Cardiologist who has some knowledge of microvascular angina.

Raised blood pressure is one of the risk factors for MVA.

The awareness of microvascular and vasospastic angina is growing amongst Cardiologists, though perhaps not fast enough.

Where in the UK are you based?

[jerry12953]

I'm in mid-Wales (Aberystwyth). Thanks for your suggestions and comments, Milkfairy; I believe even here in Wales I should have had a copy of the letter! It was a shock to get a call from someone who knew more about my condition than I did. And I take your point about asking for a cardio with actual knowledge of MVA.

[Milkfairy Heart Star in reply to jerry12953]

There is a study going on into a possible treatment for Microvascular angina.

Here is a link to the study, unfortunately there are no centres near you.

clinicaltrials.gov/ct2/show...

You may need to travel to get the help you need.

A healthcare professional has a professional obligation to involve their patients in their care.

The GMC actually stipulates that shared decision making is a required standard of good medical practice.

gmc-uk.org/ethical-guidance...

I would be tempted to raise your concerns through the Patient Advisory Liasion Service PALS or the Welsh equivalent at the hospital concerned.

[jerry12953]

It looks like there is potential for medical treatment of MVA there. Good!

But as the centres are all many miles away I don't think I'd be able to take part in the trials.

When I get to see another cardio I will go armed with more knowledge. Many thanks.

At the moment I don't feel like making an official complaint but will bear that info in mind should things not improve.