*sigh* can't get my husband's primary to take him seriously

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delvalle6

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Aug 1, 2006
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122
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vancouver, wa
Since our son had BAV, AS, AI, etc... everyone in our family has had an echocardiogram except for my husband. His MD refuses to order it-- or take him seriously. On top of our son's condition my husband has been having "episodes" of chest pain and palpitations followed by dizziness and then tiredness. She says he is too young to have heart issues. He is 32, slightly over-weight, borderline fasting glucose (110- not quite diabetic), his cholesterol is good but his triglycerides are high and his HDL is low at 29.
After two visits and a very persistant *wife* advocating for care, my husband had an ekg. It is a borderline ecg with borderline t-wave abnormalities (that's what the paper said as it printed out). The doctor didn't find his issues important enough to look at it and evaluate the ekg in conjunction with his symptoms.

I am so frustrated. Why can't she just rule out the BAV/Connective tissue disorder and go on from there? Why the big obstacle? --I think we are going to change doctors but still-- this just drags the whole thing out.

Any suggestions? (I was already kind of a bi!ch on the last appt after she summarily dismissed us)
 
Wow Samantha,

and if not mistaken you actually work in ICU in a cardiac unit?

If I am understanding this correctly your 8 year old son is identified as having multiple heart issues brewing and your 32 year husband with symptoms is too young to possibly have heart issues?
Everyone in your family has had the non invasive echocardiogram, but this test refused for your husband?
seems to me an echo for your husband is a very reasonable and non invasive test to push for and cnnot understand why not...err on the side of caution for sure
Samantha, am puzzled, you mention MD, is this roadblock a GP or a cardiologist?
 
I'm 29 years old and I was diagnosed with a BAV about six months ago. The only reason I found it was because I decided to go to a new GP (hadn't had a physical in a couple of years) that was recommended since I thought the others doctors I had seen previously were not very good.

She (the new doctor) heard a murmur and ordered an echo. My EKG during the initial physical was normal, my cholesterol was perfect, overall I appeared to be in good shape, but when the tech was looking at my heart during the echo he asked me, "You don't have trouble breathing?" That was the moment I realized there was a problem.

I had seen many other doctors in the past and no one heard the murmur. I had another doctor that wasn't a cardiologist exam me before my surgery and I asked her if she could hear a murmur and she said she could barely hear it.

If you can't change doctors, maybe at least get a referral to a cardiologist?
 
Luckyguy-- I do work in the cardiovascular ICU--- and what I have been seeing with my husband is concerning to me.... but I can't get this General Family Practitioner to refer him to the cardiologist or order the Echo. With our insurance he must be referred--and a doctor I am not. I am calling to change physicians, but the delay is disheartening. There is a part of me that wants to be sure I am not over-reacting. I hate to over react--but this has been driving me crazy.

Ross-- On it! I just hate that it means a delay-- and what worries me is my husband could get stuck with a kaiser "clone" of this MD> I wish patient care was the priority it used to be--not the bottom line.

Fiddler's Green-- nice story! Thanks-- I can't get her to refer to a cardio-- so to save time I am actually going to try to get my son's cardiologist to recommend the test. In the meantime I believe it is definately time for him to get an new Primary. It's just that he has been so healthy that we've never really "tested" out this MD-- and now that we have I am a little peeved.

It's just past 8pm here and she never bothered to call with her interpretation of the ekg--- eerrrrrr.
 
Well, he certainly needs the chest pain, palpitations and dizziness evaluated, but an echo is probably not the right test. If he has no murmur I doubt his symptoms are due to BAV and AS, AI. So, what does the GP make of these symptoms if they are not heart-related?
 
Self Advocate

Self Advocate

If there appears to be a problem and you guys aren't happy with your doctor's response, find a new doctor. Look for a doctor whom you feel comfortable with; obviously, you aren't comfortable with your current GP.

-Philip
 
Chest pains and palpitations and she says he's too young to have heart issues? Is she nuts? I'm sorry, but I was 8 when I had rheumatic fever, but, oh, wouldn't I have been way too young to have heart issues? I'm not feeling a lot of love for her. I'm guessing you're in one of those HMOs where you can change PCPs anytime, but it won't go into effect until the 1st of the next month? If you can select a PCP who is Internal Medicine, it would be better than Family Practice; he's got some stuff going on and it's very good that you are a persistent wife. Any chance you're related to our Nancy?

My suggestion: the squeaky wheel gets the oil. You know how to squeak and I'm sure you can be totally charming while you do it.:D
 
My work career was as a computer contractor. Over the years I had a lot of different insurance carriers, including some HMOs. If you have a choice you usually choose an HMO because it is cheaper. Consider an occasional out-of-pocket out-of-network evaluation as a bit of your insurance costs. It may help to go to a big-name medical center, because you will get a better opinion and because your current GP will probably bow to the more prestigious opinions you get. I took my case to Johns Hopkins and none of my HMO doctors argued with the opinions I got. It was definitely worth paying out of pocket! Also, remember that you should tell the out-of-pocket people it IS out-of-pocket. You can often negotiate a better rate.
 
Why not do an end run on your doctor and when your husband has another episode take him to the ER. Chest pains and arrhythmias and whatever else should at least get him the attention of an on call cardiologist. And think about firing this nincompoop. She hasn't got a clue and she sounds dangerous.
 
Do you have an HMO or something? If you do not, then just find a good cardiologist in your area and make an appt. I work in the medical field and you REALLY need to be your own advocate. And my suggestion if you do have an HMO, then find a new primary care doctor for your husband. Robin
 
Yeah, fire her and get a new doctor.


I second that thought. Get a real doctor it is her that is the real bitch not you!
 
Samatha,

Sounds like you are really on it and you will find the resource that will listen and check.

Am not a medical professional and as a member noted, a murmur usually drives the echo test, so spoke/wrote incorrectly.

But still, your husband is having symptoms and your GP may think it is anxiety and not to worry?...but you do well for seeking a confirmation from another medical professional, or as someone has stated, go to the ER for attention on next symptoms...both you and your husband need the piece of mind and health to support your young son.
Good on you for fighting the fight, get the peace of mind, a checkup should bring.
 
These heart issues are often inherited, so it's not at all outrageous to think that your husband might have a problem with one or two of his heart valves, or even an aneurysm. While most doctors could tell the "knock" of stenosis or the slushiness of valve regurgitation through a stethoscope, it wouldn't necessarily be plain in all cases, and maybe the stethoscope isn't her instrument. Particularly when your husband is showing symptoms, there is little good cause for restricting access to an echocardiogram, as that isn't that expensive a test, and would end a lot of concern and speculation.

It seems she may get too many of her patients through that insurance company, and may have bought in too heavily on their cost containment ideas.

An inverse or "juvenile" T-wave is not uncommon in people with valve issues. I developed one myself before the first surgery, and seem to have it still.

I know it's a pain and a delay, but I agree with "Dump the Doc." If she doesn't take her patients seriously about their symptoms, she's likely not the one for you. You can't play "insurance roulette" with your lives. If you lose, you don't get them back.

Best wishes,
 
Don't certain insurance companies give doctors a kick-back if they save money for the insurance company? Sounds like this might be the case here.
 
Don't certain insurance companies give doctors a kick-back if they save money for the insurance company? Sounds like this might be the case here.

I've heard there can be incentives for PCPs not to refer to specialists, and this may be more within their network medical group than the ins company, as an HMO will have a variety of doctors you can choose from and then many of them will be part of a group or IPA where all referrals are within that group. So the group may be rewarding the PCPs, but the group may get that reward from the ins company. Does that make sense? I've heard Kaiser Permanente penalizes doctors who give out a lot of referrals, but don't know how true that is.

I've been fortunate with every HMO I've been in not to have had a problem getting a referral. Last August when I went to see my PCP and said I'm worried I might need a heart valve replaced; one listen to my heart and I got an instant referral. My last HMO with Aetna, allowed you to change your PCP at anytime and new doc would go into effect in a few days. I've just been switched to Blue Shield, which allows you to switch anytime also, but, the change will not go into effect until the 1st of the following month -- a bit of a nuisance.

HMOs can be a nightmare, and they can also be pretty good. You either need to be a strong advocate for yourself or have a spouse or other family member who will be a strong advocate for you.
 
Thank you! At least I don't feel crazy now...
About the kickback thing-- that is a definite yes in our insurance's case. Not a kickback really, but keeping the cost per patient down increases the amount of the annual bonus. I'm not really sure how that works out for the docs- but it is disconcerting to think that he may not get the care he needs so that the doc can get a bigger bonus.

Will be calling to change docs tomorrow (monday). I don't know how long it will take me to get him an appt with the new doc-but that's what I'll do. I just hate the delay.

I'm pretty intent on him getting an echo-- the BAV/connective tissue is hereditary and he's the only one who hasn't been checked. Besides, how good are the ears on this doc? I have a murmur- but only one out of five docs can hear it. They have no idea what is causing it either. So he could easily have a "quiet" murmur that many docs miss.

Sometimes I put my hand on his chest and it just feels like his heart is slamming against my hand-- I'm not sure how normal that is but the only other person I have ever felt that with is my son Sammy. My other boys don't have that--It's wierd and a little scary sometimes. I know that on days he has had pain I sleep with my hand on his chest and any little change wakes me up. It's just a little too reminiscent of what I've gone through with my son.

And I was pretty clear that her "list of things to watch for" specifically aimed at men over the age of 50 or 65 was irrelevant. It was the strangest thing I'd ever read. She gave him a whole list of things like "I recommend a yearly rectal exam for men over 50...I recommend 1500mg of calcium for men over 65..." I can tell you, since my husband is 32 there were a few WTFs that ran through my mind when I read the 20 or so recommendations that really didn't seem to have any connection with my husband or his situation. Geez.
 

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