Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick 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 Bishop and I would like to welcome you to my consulting room. I'd like to share with you some information today about a case that I saw this week and 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. And it turns out that 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, but the other was in regard to elevated blood pressure. Now, when I'd seen him eight years ago, I had put in place a strategy to measure his 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 blood pressure profile, variability between night and day, and variability from hour to hour, whether the person's blood pressure is volatile or not. When I saw him last week, I said to him, when I look in the notes, I was meant to see you. to follow up on that test. And he turned around and basically said, I felt well and I thought if there was a problem with the test, you probably would have called me. 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. catch-all opportunity for bringing those important results to the attention of the doctor, the GP, and ultimately the patient. 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 based on that information. We don't report the tests. and call the patient back if they're abnormal, because either someone else has requested the test, in which case it's their obligation to follow it up, or if we've organised the test and we have a follow-up in place, then why would you invite the patient back for the follow-up 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 got therapy to drive that blood pressure down eight years ago if he'd turned up for the appointment, which he thought was only going to be actioned if the test was abnormal and that he felt, well, therefore there couldn't have been a problem. Turns out we had put an appointment 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 with 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 has been drawn under it, and it's come to a clear-cut conclusion. and your care has been handed back to your regular general practitioner. 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 eight years potentially of being significantly undertreated for high blood pressure, which we know is strongly linked to risk of stroke, risk of heart attack, risk of... cardiac failure development, and risk of development of atrial fibrillation. Put yourself in his shoes. Would you have rather have gone eight years without appropriate treatment for that? Or would you rather have felt well and not turned up because you thought everything was fine, waiting for a problem to arise? If we think about it, people may not turn up for their follow-up appointments with a specialist because of issues regarding cost. If that's the case, please speak to your specialist about that. Invariably, we want to see you 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, and again, please just ask. I know sometimes I get caught in my own thoughts and I'm organising 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 follow-up. I'm sure that you don't wait until your car breaks down to take it for a service and you're the same. 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, have significant consequences over many years. And if we miss the opportunity early on to address these factors, this condition, we may miss a great opportunity to avert problems down the line. So if you're not sure, just ask. Please. Your care is what we're here for. And from my side of the desk, it's extremely disappointing to see someone miss 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 a line has been 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's surveillance and appropriate care for you in the longer term. In this situation, really... Prevention is better than cure and the opportunity to get in early is far better than waiting till later on. So please, please don't miss your appointments and think about the consequence. I wish you good health. As always, take care. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
