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. Hi, my name's Dr. Warrick Bishop and I'd like to welcome you to my podcast station and of course to the Healthy Heart Network. Today I'd like to tell you a story about Brian who represents a really good example of being lost to follow-up and lost to rehabilitation after a heart attack. Brian was about 65 years of age when he came to see me. It turns out that he'd had a heart attack about 10 years earlier. When I saw him, he was a slim man. He was wearing jeans, sand shoes. He had a t-shirt on and tucked under the sleeve of his t-shirt on his left shoulder was a packet of cigarettes. He looked older than his stated years and I think that was related to... Probably a hard life, but to a large degree the cigarettes, which I'm sure were contributory to his heart attack at a young age. Brian came in and sat down and the referral basically said something like, hasn't seen a doctor for 10 years after his heart attack, please assess. Well, I started talking to Brian and I don't know if you can relate to this, but it became very apparent to me. that he just didn't like me he was angry he was um there was a real drop in the temperature in the room and honestly it was uncomfortable i almost felt like this person was directing that anger at me so much so that five or ten minutes into the consultation i said look brian I'm going to just take a different tack here, but I can't help but feel you're angry at me. And I don't understand why. We've never met before. I didn't ask you to come here. Your doctor sent me a referral and you've come of your own volition. And yet you seem to be really cross at me. And yet what I would like to do is try and help you if I possibly can. And it's really hard to try and help someone who's almost threatening. I said, so look, if you don't want to be here, that's absolutely fine. Please, it's been nice to meet you and I wish you the very best if you'd like to go. That's absolutely fine. But if you would like to stay, we've got to get on a bit better and you can't sit there being angry at me because it's uncomfortable and I really can't help you. Well, believe it or not, Brian actually took a breath after that. and and said he just didn't like doctors i said well that's reasonable but still you don't know me and i said my experience is generally people don't really not like doctors because that's a bit of a generalization and often doctors are quite nice people i mean we have families and mothers and fathers and siblings and you know often we can be quite nice people i said my experience is when Patients say they don't like doctors. What they're really saying is that they're scared of what's associated with seeing a doctor. And for you, I imagine that you're scared about what happened to your heart 10 years ago and what might happen in the future. Anyway, believe it or not, Brian loosened up a bit and he did soften up. did engage in the consultation and I had the chance to go through his past history look at his current medications I could look at where his cholesterol levels were and because he hadn't been seen for 10 years there's a whole lot of stuff we could do with his cholesterol for example because the parameters had changed we could look at his blood pressure and also really get a good handle on his symptoms and for a guy who was really quite young in the scheme of things He was limited in terms of what he was able to do. Look, I spent a bit more than a standard consultation with Brian because I knew there was every chance I would never see him again. And what I did was, in a systematic way, try and think about all the things that could or should be done for him. And I tried to prioritise those. And really... Right back to the GP with a checklist, if you like, of about six or seven different things to implement. You know, the first thing might have been to add in a little bit of beta blocker. The second thing might have been to have added in a little bit of isosorbide mononitrate. Both those agents to help with anginal type symptoms and maybe improve function. I may have suggested... an ACE inhibitor because of his previous heart attack and scars so that we could help with remodeling of the heart. Look, I can't remember the items, but basically I created this shopping list for the GP to work through when Brian presented back to the GP in the future, thinking I would never see him again. So, and I tried to prioritise that item list, if you like, so that the first on the list would give the most bang. for the buck for Brian. Anyway by the time Brian left we actually shook hands and I wished him the very best and invited him to keep in close contact with his GP who I know is a really good guy, relates well to patients and was going to follow through on all the recommendations I'd put together for Brian. Well, I didn't think of this gentleman again at all, actually. I just got on with the day, got on with the week, and got on with the months ahead. Until, lo and behold, about three or four months later, I walked into my waiting room, and I kid you not, Brian's sitting there. I took a double take. I looked at him, I looked away, I looked back. I said, mate, what are you doing here? When I saw you last, I thought I would never see you again. He says, Doc, you made me feel so well the last time. I thought I'd come back and give you another go. So, you can imagine how pleased I was to have had the opportunity. to make a difference for this man to such a degree that he even made the effort to come back and see me. Quite an extraordinary case, but one that I think really nicely represents the need to follow up with your cardiologist on a regular basis if you've ever had any problems. Rehabilitation is the process of... Really making sure that everything is done as well as possible for you after a heart attack. That's reducing symptoms into the future. That's restoring your level of function. That's reducing symptoms into the future. It's everything. It's ensuring that targets are met. It's ensuring that the tablets are tolerated. It's ensuring you understand what the process is. Dear Brian had been completely lost to rehab. lost a follow-up and I'm sorry to say that his health, his best health, suffered because of it. I was absolutely delighted to have been able to engage with him and make a difference and for him to come back. But he's a great example of how not to look after your heart after you've had a problem. If you have had a problem with your ticker, please make sure you follow up with your cardiologist. Guidelines are changing all the time. Medications are changing regularly. Unless we know how you're feeling, what symptoms you have, what your life is like on a daily basis, we can't know if we can help you. And sometimes minor adjustments may be all that's required to make a major difference. Well, don't do a Brian. You be proactive. You look after yourself. and understand that although you might not like doctors, we do set out to try and help where we can. I hope you've enjoyed this little story about Brian, who was a memorable patient. I hope you don't behave like him. I can't tell you for sure if he's quit the smokes or not. It would be a nice story if he did. But what I'd like to do is encourage you to make sure you keep in touch with your doctor if you've ever had a problem. I hope you've enjoyed this story. If you have any queries or questions, then our email is members at drWarrickbishop.online. Please drop us a note, ask any questions. If you have any suggestions for future podcasts, let us know. As always, thank you so much for taking the time to listen. I wish you the very best health and please don't die from a heart attack. Goodbye. 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.
