It is remarkable hearing some of the nightmare coumadin clinic stories.My first cardiologist & his "team" who monitored & prescribed my INR did not understand the concept of being much safer to try to maintain an even INR (through dosing weekly then dividing by 7) instead of daily doing whatever dosage they happened to decide on in response to my INR resulting in a roller coaster effect. They had me taking something like 3-4x my other daily doses on Mon or Tues, so that I had a yo-yo INR peaking end of the week then falling off a cliff then bouncing way back up. Oh & in addition I would get phone messages from them telling me to increase (or decrease) my dose to X even though I already was taking that amount or was just told by them to change from that like the previous day. THEY HAD NO CLUE AS TO WHAT THEY WERE DOING AND ONLY GOT INSULTED AND SHORT TEMPERED WITH ME IF I TRIED TO DISCUSS THE SITUATION. I had to beg my primary physician to take over the INR "management" and had a discussion with him about it, even showing him guidelines from the Cleveland Clinic (which my cardiologist's people refused to even look at!), which he agreed with and acknowledged that the dosing should be as consistent as possible, and to aim for a consistent INR, not one bouncing from below range to above range.
There was a lot more to this as well which shocked me regarding the misinformation this cardiologist was involved in that I won't go into, other than to say that this was just one of literally HUNDREDS of medically nonsensical situations I have been put in over the years, and anyone who BLINDLY follows their Dr's instructions is quite frankly a fool.
I have my own. About 9 days out of the hospital I received my own meter and started self-testing. The clinic asked that I send them a message through the portal of my weekly results. They would then give me "guidance" which was a joke.
I was always in range, so their guidance was basically: "Good job. Keep taking 4mg of warfarin per day."
I think found out that for this "guidance" they were billing insurance $505 each time I sent them my results. Even though I had reached my deductible, this was a gross overcharge for services, so I stopped reporting them the results, just so that they would echo back to me to keep taking what I was taking.
So, 4 months pass. Two changes during that time. my cariologist changed my INR range from 2.5-3.5 to 2.0 to 3.0. And I now was taking about 7mg warfarin per day vs 4mg, as it is common to need a gradually increasing dosage during the first few months on warfarin.
So, at my follow up cardio appointment, my doc was ordering some blood work and I asked him to include an INR test so that I can check the accuracy of my meter, which I like to do from time to time.
So, my INR comes about at 2.3, which is in range. To my surprise I get a message from the coumadin clinic- I thought that because my cardio ordered it that it would just go to him. Apparently, I was still in the system as under their care. Along with an urgent voicemail with the same message, I was informed that I was out of range and needed to go immediately to the pharmacy to pick up a prescription for injectable Lovenox right away, which they had already called in. They also told me to start taking 4.5mg of warfarin, which, even if my INR was below range (it wasn’t) would have made zero sense, because I was now taking 7mg per day. Even though 4 months had passed since I last had communication with them, they did not bother to check with me to see what my current warfarin dosage was.
It is really important to pay attention to the guidance they give and ask ourselves if it makes sense. In this case it was really really bad guidance, and it was the third time that they made a big screw up. So, I fired them. I actually thought that I already had fired them, but apparently I needed an instruction from my cardiologist to officially dis-enroll me, which he was happy to do.