DrWarrickPodcastS1E4 from Dr Warrick Bishop on Vimeo.
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Warrick is a practicing cardiologist an author with a passion for improving care by helping patients understand their heart health through education work believes educated patients get the best health care discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.
I’m Dr Warrick and I would like to welcome you to my consulting room. I want to share with you some information today about a case that I saw this week. The important message about this case is please, please don’t miss your follow up appointments.
I had a patient come and see me earlier this week, it turns out when I last saw him approximately eight years ago at that time there were a couple of issues that we were following up. One was in regard to an irregular heartbeat. The other was in regard to elevated blood pressure. Now when I had seen him eight years ago I had put in place a strategy to monitor blood pressure using a cuff that he could wear for 24 hours. That blood pressure cuff is a really good way to get blood pressure measurements over a 24 hour period to give us an idea of his blood pressure profile, variability between night and day and variability from hour to hour. It will also tell us if the person’s blood pressure is volatile or not.
When I saw him last week I said to him, “when I look at the notes I was meant to see you to follow up on that test 8 years ago” and he turned around and basically said he felt well and thought if there was a problem with the test I probably would have called him. Well, I guess I can understand that logic. The reality, however, is that a lot of medical practice systems don’t have a safety net like that. That catch-all opportunity for bringing those important results to the attention the doctor the GP and ultimately the patients in our practice, the safety net we use, is bringing the patient back with that result to make sure that it’s dealt with and that the cardiologist provides the appropriate advice on that information. We don’t report the tests and call the patient back if they are abnormal because either someone else has requested the test in which case it’s their obligation to follow it up with the patient or if we arranged the test we have a follow up in place, after all that is our safety net. Then why would we call the patient back for an appointment which is already booked?
The long and short of it is that for this gentleman eight years ago he had a markedly elevated blood pressure, and there’s no question he would have gone onto therapy to drive that blood pressure down. Eight years ago he failed to turn up for the appointment which he thought was only going to be actioned if findings were abnormal and by the way “he felt well”. Therefore they couldn’t have been a problem. Turns out we had put a plan in place. He just thought that it wasn’t required because nobody called him up and said that result that you’re going to be discussing Dr. Bishop is abnormal. From my perspective, I would really like you to consider that if you are seeing a specialist for a particular condition or issue make sure that if you do believe you’ve had a final appointment with that specialist that the condition has been summed up, a line is being drawn under it and it’s come to a clear-cut conclusion and your care has been handed back to your regular doctor.
I really didn’t spend much time speaking with this patient about why he didn’t follow up. But the consequence for him was huge. He’s had years potentially been significantly under treated for high blood pressure which we know is ...