Is my doctor a jerk or not?

[Christina]

I am so mad right now, I can spit. I had a fight with my regular PCP. He's the one who is regulating my Coumadin and the last time I checked in with him was two weeks ago.
My INR was fine at that time, and he told me to check my INR again in two weeks.
I disregarded that because I check my INR every week or if needed twice.
Well, when I checked my INR last week it was low (2.1) and I adjusted my Coumadin accordingly. I did not call it in to him as they had told me to check with the office again in two weeks. Well, today I checked and called it in to the office. I told them that my INR was low last week and that I had adjusted the Coumadin accordingly. The nurse put me on hold, and after a few minutes the doctor got on, and boy was he mad!
He said, you do as I say, and when I tell you to check your INR every two weeks, I expect you to do exactly that.
You did not go to medical school, and you don't know what you are doing. You are not to adjust your own Coumadin, and must leave that to me, and if you can't do that, than I urge you to find another doctor.
I reminded him again that I prefer to check my INR every week or more because I want to avoid any further problems. He again said that if HE tells me to check my INR every two weeks that I am to listen to that, or else I can find another doctor.
This is about everything he said word for word. We were on the phone for maybe 5 minutes in total. I am still shaking!
I think I know what I am doing by now, and don't intend to act stupid with this medicine. I now regret letting them know that I adjusted my Coumadin last week. I should have just kept my mouth shut.

I just needed to get this off my scarred chest, I am so upset. I want you to tell if me if I was out of line as a patient by adjusting my own Coumadin.
I think I have every right to check my INR as often as I think it is needed. That's why I bought the machine, for cryin out loud.
I want to fire this doctor.

Christina.

Update 7/12/01. As of July 30th, he is history.
Today my lab results were 4.9 which is very high, and my protime machine results were 3.2. Now this arrogant blanketheblank you know what tells me to get rid of my machine because it can not be trusted.
How much you wanna bet that the lab was wrong!
I am doing another test tonight.

 

[strayze]

I had the identical problem with a doc I finally found after a 3 month interval which included surgeries, with noone to monitor my anticoagulation. So he was a desperation choice as docs here don't like to do Coumadin monitoring. Nearly the same words were exchanged! After being told that I had no knowledge, I told him I taught biochemistry to med students in med school for 18 years (naming the institution), and that coagulation and fibrinolysis were two of the topics I taught. I wasn't trying to be cheeky, but I truly was appalled by this young man's attitude. That went over like thud and there was absolutely no communication thereon out. He did a woeful job of Coumadin monitoring as there was no discussion about the other meds I was on, the chemotherapy, the physiological variables that affect Coumadin levels, etc. After he made a remarkably stupid and dangerous error in thyroid monitoring, I could no longer use his services, dosed myself for several months till I could get a real doc at the teaching hospital some distance from here. (This young man had not had my thyroid lectures either.) I'm getting a home monitor even though insurance does not cover, as it's worth it to avoid the jackpots.

 

[Laura]

Doctors and Coumadin

Doctors and Coumadin

Just before I logged on to check the site I was complaining to my fiance about how they can't get my coumadin regulated yet and that they never call me the day I have my protime tested and therefore am off a dose the next day. They have a registered nurse (I guess) keeping track of this and calling the patients. My fiance told me to call my actual doctor and tell her I am unhappy. Then today they said I was at 2.5 and that is within the range to be at so they were going to leave things alone this week and check again next week. I could swear I was told my INR was to be between 3.0 and 3.5 due to a new valve. They keep bouncing me between 2 and 4 MG. We don't understand why they won't just put me on 3MG daily and see how that goes. I agree. This does tend to get very frustrating! Glad I'm not the only one struggling to find a happy medium.

 

[Phil]

I have learned that a person must be medically defensive. You are in charge of your body and its health. If taking a PT twice a week makes you feel safe, then so be it. The doctor has no right to put you down any any manner what-so-ever!

It was my doctor of 30 years that told me I had the ?flu? even though he said I had ?one hell of a heart murmur?. He medicated me for the flu and sent me home. 4 days later I was in the hospital with severe baterial endocarditas, which caused me to have my Mitro Valve replaced.

He?s now talking to my attorneys. Bottom line, get a new doctor.

 

[LUVMyBirman]

Hi Christina

Fire him my friend. I went though this with a hematologist.....but at that he would not prescribe the home test kit for me. His nurses had me bouncing all over the place changing my dose constantly. Finally I put myself on a "fixed dose" did not tell them and I stabilized. I am not suggesting anyone do this, was at the end of my rope. He was a very good doctor, helped me in a lot of ways....but it was time to move on. For the last 7 months I have been self regulating at home with the Coaguchek, testing once a week. It has saved me a few times.

Take care
Gina

 

[Tammy]

Christina -
I am in agreement with the others - its time to change Doctors.
Some Doctors just think we're all idiots. Although he may have been looking out for your best interests, he did not handle it very well. You don't need someone talking down to you, you need a Doctor that will talk to you.
Good Luck - You will find the right one!

Tammy

 

[DickV]

New Dr.

New Dr.

I have been on Coumadin for a little over a year and discovered you develop a pretty good sense of your doseage. My Cardo and I actually discuss my doseage and once we disagreed. I thought his change would raise my INR too much so we actually agreed to "split the difference." I self moniter some and he supports it completely. We are in the stage of joint testing so we can establish the variance in the two machines . I paid for it myself and believe it is well worth the bucks.

Moral of the story is that there are decent dr's who will work with you. You just need to find one.

 

[strayze]

My experience with doctor-monitored anticoagulation therapy (that is when one can actually find one here who will agree to do it and to be one's gp) is:

Feedback is at times nonexistent. Sometimes a letter 1-2 weeks after the blood draw, sometimes nothing, occassionally a phone call within a week, never before 3 days.

The feedback in unrelated to the severity of INR deviation. At one time with an INR of 1.56 (learned a couple of weeks later) on the day after the draw I threw a clot to the brain while traveling fast on interstate, putting my life and others in danger. When the doc was confronted face to face, was told that it's not a bad INR. Other stories, etc. etc.

I made arrangements with the lab to send me directly the results in addition to the doc. The doc gets them the day of the draw or early next day. But since I'm a patient, I get them 1 week later from the lab. At least I get them so that I can track old history. Occassionally I'll get them as soon as 3 days. Almost always, I get the results faster from the lab than from the doc, no matter how off the INR is.

There is no way to communicate with the doc other than appearing in the office and attempting to communicate. I bring a letter of concerns. This is very tiring and trying. His office phone is always busy. His emergency procedure is to call a general hospital nurse who tells you to call yourself, even if you cannot get through. I guess anticoagulation problems are not an emergency.

Whatever communication that exists with nurse or doctor is chaotic. I've come to the conclusion that there are serious record-keeping and interoffice communication problems. That the business stress I pose to that office with anticoagulation monitoring is far too great to handle. Going to another doctor is not the solution as there are no doctors taking patients in this doctor-starved area.


I've gotten better results on anticoagulation by going to Urgent Care. Occassionally can get a blood draw for INR with feedback.

After being on a 6 month waiting list, I finally got into the nearest "Coumadin Clinic 75 minutes from here. That has worked fine, and the long drive is less stressful to me than attempting to get local Coumadin monitoring. (I must medicate with dexedrine in order to legally drive because of my long term CNS narcolepsy.)

 

[Sierra Bob]

Hi Christina---My vote is the same as everyone else. Get a new doc that recognizes he is working for you. I monitor my own INR, sometimes once a week and sometimes more often if I've done something like eat a big salad that can change the coagulation time, and I adjust the Coumadin dosage accordingly, all with the blessing and approval of my physician. Like some of the others, when my doctor was drawing the blood, it took two days to get the results back from the lab. In March, 2000, my INR went to 11.4 and I started bleeding internally and spent eight days in the hospital (also had pneumonia). My doctor was making too big of a change in the Coumadin dosage and then it was taking too long to get the results. The basic reason for the high INR is that I had been drinking four cans of Ensure each day because of the extreme weight loss I had due to radiation of my head and neck because of cancer. After my weight got back to where my Cardiologist wanted it, I stopped the Ensure. I did not realize at the time that four cans of Ensure equalled the total daily requirement for vitamin K, so when I stopped drinking Ensure, I was getting too much Coumadin. You have every right to be upset. Regards and good luck in getting a new and understanding doctor. Sierra Bob

 

[DickV]

My arrangement with my dr. is that I fax my INR results to him. He writes on the same fax to change or keep the current doseage and faxes it back to me. I get a turnaround the same day and it takes about 5 minutes of his time. Also, my fax page is cumulative so he can see all past INR's with their dates. It is a running record. I also include the doseage for each month. In the end, we both have a record of the current status. Works for us.

 

[Rain]

When I have blood drawn, I sign a release for the information at the time of the draw. Then I'm able to call back later in the day and get my INR results over the phone. I'm not sure if this works because I live in a small town and the people know me? But it's worth a try. It sure made my life easier before I got my own monitor.

Now I fax the results to my doctor. He faxes it back.. works great.

I think every heart valve should come with it's own pro time monitor. They should put one in that bag full of junk they send home with you after heart surgery!!

Rain

 

[Marty]

Yes, your doctor is a jerk! Start looking for another one pronto.
At your first visit with your new doctor explain your problem with the jerk and see how he feels about it. Tell him you not only wish to self test but you wish to at least partially self regulate your Coumadin dose. My cardiologist loves patients who do this and believes they do better. The clinical trials done in Germany and Denmark support the evidence that patients who self regulate stay in tighter control.At the AC Forum meeting in Washington I heard many horror stories how anticoagulation is mismanaged or non managed. I am going to add yours to them.
Marty

 

[Bill Hall]

Christina - I don't think it is a good idea to self-medicate, however you did the right thing by making a change and then informing your doctor. Of course, he did three things wrong that he should regret. First, he did not explain why his instructions were right and yours were wrong. Second, your INR was too low, so he was willing to put you in danger. Third, he broke down your communications with him and tried to bully your soft personality. As you know three strikes and you're out, so I agree with everyone else and would go find a different doctor.

 

[Christina]

My BULLY/JERK doctor is out the door as of July 1st..

My BULLY/JERK doctor is out the door as of July 1st..

Hi to all my heart buddies that have replied to my post.

I have had earlier problems with this doctor (regular PCP, young guy, maybe 35 and looks like the guy on JAG, really handsome) but since I hate to change doctors, I wanted to give him another chance. I thought maybe he had a bad day the first time like we all do at times. I know first hand that he is fighting breast cancer, so I felt for him, but the way he spoke to me yesterday, and how he said it is totally unacceptable to me. It was like I heard my Dad scolding me when I was a child and had done something wrong. But this is it! I have had it with this creep. He thinks just because I did not go to medical school that I am an idiot, and that I don't have a brain.
The hardest part was not stooping down to his level and give it to him. It is just not in my nature to do that. I have more class, so I bit my tongue.

I don't want to totally self medicate this anticoagulation therapy yet. It is still a bit scary to me, and I don't want to screw up and bleed to death, or get another blood clot.
Maybe in the future I will feel more confidant, but for now I need to check in with a doctor maybe every two weeks.
I already have another doctor lined up. She's also into alternative medicine just like me, and I had her on the back burner just in case the jerk wouldn't work out. He is also the one that would not write a letter for me telling the insurance company that the Protime machine was medically necessary. But I did get my cardiologist to write a letter, and I am awaiting the Insurance companies decision. Fourt time that I am appealing, but this is the last time.

Anyway, thanks to all. HUGS!!!

Christina

 

[bigjim]

Get rid of this medical practice and find omeone who is responsive and willing to save your life.

While weekly may be too frequent after things calm down, you will always be the best one to have input to the office that is suppose to be rewsponsible.

Not a unique experience unfortunately.

 

[strayze]

Unfortunately in this neck of the woods finding a "Coumadin" doctor is just about impossible, leaving me to bear up under inadequate care from an egomaniac. After the last clotting due directly to malpractice, I directly confronted the "wizard of oz" at the next rare office visit. The original purpose of the visit was not accomplished. (The "wizard" hides behind a busy phone and doesn't return calls, etc. or inform people of their inrs).

I brought alone literature from three manufacturers of home prothrombin time monitors, some peer reviewed literature on the superiority of home monitors done in several countried, and the FDA regulations. I left his office with his prescription for a home monitor.

I so very angry that there had been so much sloppiness and with my TIA when my inr was 1.56. It was all I could do to confront this person. But all in all, everything worked out well, and I believe he felt off the hook with his prescription, for which I was truly grateful. He did not know about home monitors. but is now getting one for his office.

I now get monitored at the teaching hospital some distance from here.

 

[cookie]

Christina,
Some docs have this "attitude" thing! My cardiologist was one of them! Needles to say I have a new doc. My PCP just switched me to an anti-coagulation clinic that just opened here locally affiliated with the local hospital. The pharmacist that does the monitoring is super nice and they also have a doc on board. I'm glad my PCP recognized the fact that he was just too swamped to handle all the patients on Coumadin and get them their results in a timely fashion. The clinic uses an Avosure? machine so I get my results immediately and we discuss any changes etc. right there before I leave. The one question I have about this is the finger prick machine and the blood draw from the arm just as accurate? I had heard that blood draw results can vary because of handling, too much shaking, bruising the platelets, etc. So which is the better way to go? Or should you have an arm blood draw periodically to compare?

 

[DickV]

I am doing both. Home testing with periodic lab work at the dr's office. We are still going through the process but I expect I will end up doing lab work every 3 to 6 months depending on what we decide.

 

[Jeff Summers]

Christina,

My advice is to get a new doctor ASAP, because this guy is starting to mess with your head, and you will always remember the bad things that this guy has said to you.

I don't recommend changing dosage with out medical advice. I get tested every 4 weeks, get the test results within 24 hours. I chart all my results, and when a dosage level is required, the Dr and I look at it from a statistical stand point-if we increase dosage X% what should we see on the next test, which is 2 weeks after the dose change.

I had 1 office visit with my primary care phys (lets call him Dr Jerk), that hooked me up with a great cardio guy, before I had my surgery. Dr Jerk and I butted heads from day one, but he came highly recommended. Well, it came to a head one day in his office, and after a verbal assault by him, I returned it with twice the fire power. The next day I began a search for a new Dr, and 1 week later I received a letter from Dr Jerk. HE FIRED ME! My HMO has seen this happen on rare occasions, my Cardio was shocked. It was a matter of 2 personalities clashing, and a Dr who thought he was always right, and not customer/service oriented. I have since found a Dr, who listens, and does not pretend to know everything. We work well together, and it is much healthier for me physically and mentally. Every person I know has a bad Dr story. I have my fair share, but I can honestly say that I have had more good stories than bad ones.

I am trying to get my own pro-time machine, and I am currently in the appeal stage with my HMO. I am using Veina scarring, and peace of mind as a defense. I was initally denied-considered a convenience item-but I hope to change their minds. My levels are pretty consistant between 2.5-3.5, so I just try not to worry about it. Good luck

 

[Greg H.]

Fire him! Doctors do not seem to realize that you employ them to investigate your health concerns. Even though your money typically goes through an intermediary (Insurance), you are still paying for their service.

I have had a similar situation with my new cardiologist. I started seeing a new cardiologist in February who's office is closer to home that the other cardiologist. My original cariologist and his staff wanted me to eat what I wanted as long as I was consistent. They would adjust the coumadin accordingly. Since I started visiting the new office, they have told me that I cannot eat any green vegetables and that the coumadin dose should not be adjusted. And when I suggest a dosage plan, they reassure me that the dosage is not of my concern. While I do not have a Medical degree, I am a degreed Mechanical Engineer. I solve problems as part of my job. I have ordered a Pro-time machine and intend to fire my new doctor soon.

The others who have posted on this are right - you must take control of your care and not accept substandard performance. It is obvious that we are the experts of our own problems, regardless of education. The doctor you visit should respect your knowledge.

Good luck in finding someone you can trust and who will respect you.

Greg