Should I really fire my doc?
Part 2 of DrRich's 3-part series on syncope (fainting) was entitled "When should you fire your doctor?" A few days after this article was posted, RADAMS8484 called DrRich's bluff. Here's the exchange.
From: Radams8484
To: HeartDisease.Guide
DrRich,
I was being evaluated for a black out spell last week, and my doctor ordered a brain scan and a carotid artery test, as well as a Holter monitor test, an EKG and a blood sugar test. He says he doesn't know why I passed out in church two weeks ago, and he needs all these tests to find out.
Then I read your article. Should I really fire him?
From: HeartDisease.Guide
To: Radams8484
I don't know whether you (in particular) should fire your doctor (in particular) because of his (putting it mildly) less-than-exemplary workup of your syncope.
But look, this guy has committed at least 3 of the 4 Big Mistakes that doctors commit when evaluating syncope. ( Click here for the 4 Big Mistakes. )
1) He ordered a carotid study. (Carotid artery disease does not cause syncope.) 2) He ordered a Holter monitor study. (If he thinks you might have had a heart arrhythmia that produced syncope, you need to be in the hospital, not at home posting on forums.) 3) He ordered a shotgun-load full of screening tests. (After doing a history and physical exam, his workup should be MUCH more focused.) I wouldn't be surprised if he committed the fourth error as well (failing to seriously consider underlying cardiac disease), but it wouldn't be fair to convict him of this one with the information you've supplied. At the very least, your doctor isn't paying attention. And it's entirely possible that he's totally ignorant of how to evaluate syncope.
I can't really say whether you ought to fire your doctor for all time. (He may be a brilliant ulcer man, say, or your brother-in-law, for instance.) But if you want to know what caused your syncope (and indeed, you should want to know) you ought to consider benching this guy, at least for this game, and going to a doctor who actually knows how to do the workup.
From: RADAMS8484
To: HeartDisease.Guide
DrRich,
Since I last posted, a lot has happened.
After all the tests I told you about, my doctor still didn't know why I passed out. He said don't worry about it. But I took your advice and went to another doctor.
This one seemed like he'd read your articles. He zero'd right in to my heart (which, as far as I knew, was OK), and within 15 minutes was ordering an echo test. The echo showed something, and the next thing I knew I was in a cardiac unit.
It turns out I had a small heart attack at some time in the past. It was a big surprise. I'm 56, a smoker, probably a little too fat, but really have felt pretty good. Anyway, I saw an EP doc who did one of those EP studies, and next day I got an implantable defibrullator. They said I was lucky to be alive, but said the defibrullator would save me if I passed out again. They said I passed out from tachycardia, I guess the tachycardia you mentioned in your articles.
So I'm back home, feeling pretty good now but a little scared. Just sitting here waiting for the defibrullator to shock me, and its a little scary.
I should probably thank you for pushing me to another doctor, but in a way I wish I'd just forgotten about it like the first doc said. (Not really.)
To: Radams8484
From: HENSYLEE
Another lucky one, like me. I went to emerg room Dec 28th and the dr there gave me propulcid (which was banned the next week for causing heart problems) and sent me home. It was a heart attack. I sure was a sick puppy, but my dr had scheduled me for a stress test, which led to one of those tests where they go into your leg to check your heart and they found blocked arteries. Had quad bypass!
You are now on a new road where you have to do some stuff, like watch your cholesterol, ease up or stop smoking (I smoked a long time and knew I could never quit, but day before surgery, I put them down and have not wanted them since; a miracle in itself), take your medicine, de-stress your life and follow dr orders. I wish you many years of health. Take care of yourself and keep coming back here.
To: Radams8484
From: HeartDisease.Guide
That's quite a story. Whether you're happy about it or not, I am very glad you went to a doctor who addressed your syncope with the respect it deserved.
Many fainting spells that doctors write off are actually "mini cardiac arrests," ESPECIALLY those that occur in middle aged men with risk factors for coronary artery disease. Your new doctor did exactly the right thing.
The implantable defibrillator is extremely effective in preventing sudden death from heart rhythm disturbances. I know it can be a little frightening to even think about it, especially at first. Most doctors who use these devices can refer you to a support group of people who also have implantable defibrillators, and it can be immensely helpful to be able to talk to others who have had the same experience you're having (and to see how well they're living.) Ask your doctor about it.
If he/she can't help, this link can put you in touch with some on-line support for patients with defibrillators (or pacemakers). Best of luck, and keep in touch.
http://heartdisease.about.com/health/heartdisease/cs/defibrillators/index.htm
DrRich
Come on in! The forum's fine!
