Don’t Miss Your Appointments

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 strongly linked to risk of stroke, risk of heart attack, risk of atrial fibrillation and cardiac failure!

Put yourself in his shoes would you have rather have gone eight years without appropriate treatment because you felt fine or would you rather have had proper therapy? Waiting for a problem to arise. If we think about it people may not turn up for their follow up appointments with the specialist because of issues regarding cost. If that’s the case please speak to your specialist about that.Invariably we want to see patients treated the right way and we invariably want to find a way for you to be able to do that.

Some patients might think they’re being over serviced. It’s a very fair and valid concern anything. Please just ask. I know sometimes I get caught in my own thoughts and I’m organizing tests and planning the next consultation, and even the consultation after that without necessarily keeping the patient informed of exactly what I’m thinking, and in that situation, if the person were to ask “Do I really need this test, is that really required?” then, of course, I can deconstruct that and explain where my thoughts are. The thought processes and the objectives we’re trying to meet.

Unfortunately feeling well doesn’t mean you don’t have to turn up for your appointment.

I’m sure that you don’t wait until your car breaks down to take it for service and you’ll miss something. Please make sure that if there is something that needs to be sorted out, even if you’re feeling well you get it sorted out because some of these issues particularly something like blood pressure in this example has significant consequences over many years. And if we miss the opportunity early on to address these factors we may miss a great opportunity to avoid problems down the line.

So if you’re not sure, just ask. Your care is what we’re here for, and from my side of the desk, it’s extremely disappointing to see someone missing out on an opportunity. We’re talking about an opportunity for the single most important thing that you have which is your health. Money can’t buy that. I really want to leave you with the strong message that if you’ve got a follow-up appointment please turn up for it. If you do have a condition that’s being sorted out by your specialist before you return to your GP and stop seeing that specialist you’ve made sure that that particular condition has been sorted out and line is being drawn underneath it and you are fine to return or that there is an appropriate follow up strategy in place to make sure that there is surveillance and appropriate care for you in the longer term. In this situation prevention is better than cure. The opportunity to get in early is far better than waiting till later on. So, please. Please don’t miss your appointments. Think about the consequences. I wish you good health as always. Take care.

To view this post as a video, visit here:

https://drwarrickbishop.com/ep04-dont-miss-your-appointments/