EP vs. cardiologist

I am told by my cardiologist thatI have to make a decision between seeing him only on a regular basis or switching to the EP full time. My dilemma is this: I really like the cardiologist but I really dislike his device nurse. At best I think she's inept and I strongly suspect she's incompetent. One advantage is the company sends a representative to be present for the appointments.

I very much like the EP but I understand that my procedure is over and I probably don't need an EP.  He has offered to manage my medications and continue seeing me. I've liked their device clinic. The downside is frankly it's the busiest practice I've ever seen. They have 17 doctors and literally thousands of patients. 

I had an appointment today with the cardiologist and he informed me that he thought I had moved all of my care to the EP. This is what this device nurse told him. I had specifically told her I was not doing that. I opted not to say anything other than I never said that. I felt uncomfortable and I felt our relationship was not as warm as it had been. 

I think it all comes down to I can't speak with the doctor directly when I call. I have to relay my concern or message through a nurse who may or may not convey it accurately. The device nurse is more than that. I think I didn't need to see him today but when I called with a concern about my medication, the nurse taking the call concluded I needed to come in to see him. He clearly didn't agree and I didn't see the point as it could be handled on the phone. I can see there is a practice problem but off hours, I've been assured the doctors are excellent at getting back to you although I've personally never called them off hours.

I'm thinking I'm best to stay with my cardiologist who really has been thorough in trying to help me and hope for the best on the device nurse. From what I understand I may only have to see her in person once a year. And I'm hoping with a company representative present, I can make the best of the appointment with their inclusion. I'll be honest, I can't imagine letting this woman make adjustments to my pm. This is precisely what she said to me on the phone about my interrogation:"I'm going to make your heart rate go very fast and you're not going to like it, but I have to do it "

Lord be with me.




What is your point?

by ar_vin - 2021-04-14 18:35:40

In this day and age you're still expecting to "talk on the phone" with your physician outside of appointment times? Sounds rather ridiculous; I don't know any physician that has the luxury of time to spend time chatting "on the phone" unless it's a billable appointment.

However, *every* physician I see now (and have seen in the past 10 years at least) is reachable via email and respond to my emails in detail. Note that that's the expectation I set with them before I sign on as a patient. There was one physician (a bit older, about my age) who always had his "assistant" respond to emails - I chose to move on because there was always a disconnect. In fact I usually email my doctor before an appointment with a list of things I expect to cover in the upcoming appoinment (in person or online). At the end of the appointment if not everything is covered I remind them to respond via email at their convenience. It might even take a week but my concerns are always addressed. No one likes to be surprised with a bunch of questions that they're not fully prepared to respond - I simply suggest that they research the issue and get back to me in time.

This has really helped me get the most of my appointments and establish a mechanism to address questions that might not need an appointment.

From what I've seen (at least in the US) more and more practices have made  email access via a secure patient portal (along with all records, test results, appoinments, billing etc) to all their doctors.



Maybe you missed my question.

by Pharnowa - 2021-04-14 19:13:41

This is a small town practice and clinical information on email is discouraged.  I do use email with a University based doctor.

I contacted him in regard to stopping a medication. From his reaction at my appointment this morning, he clearly would have Preferred taking a minute on the phone to avoid a whole appointment for that question. However, his nurse insisted I come in and I complied. The"disconnect," was one on my points.

My one doctor of 35 years has given me every phone number he has; we've never "chatted." On a recent problem with the lab, he instructed me to give the lab his cell number so he could straighten them out. I have worked with doctors most of my career and all of the doctors I have worked with do one heck of a lot of work on the phone. It saves thier valuable appointment time. 

When it makes everybody's life easier, it really isn't "ridiculous."

EP or cardiologist

by AgentX86 - 2021-04-14 22:00:07

The answer to this question depends on the rest of your cardiac needs.  If you had an EP before you needed your PM, you may still need one.  If your cardiologist referred you to the EP for a pm implant, perhaps not.  If you have an arrhythmia, I'd vote for the EP.  If you have other structural heart disease, you need a cardiologist.  If you have both, well, you need both.

I do but my arrhythmias have been masked by the AV ablation so I don't feel them.  Since I'm no longer symptomatic, I don't really need the EP, though he wants to take a look once a year. 

My cardiologist handles everything else, including the annual echocardiogram.  They both work for the same hospital system so records are accessable by both.  My cardiologist is an interventional cardiologist and does implants but because of my arrhythmias passed me off the the EP well before I needed a PM (antiarrhymic drugs did that work).

How lovely to hear from you Pharnowa

by Gemita - 2021-04-15 02:42:22

My Cardiologist here in the UK is also an excellent EP.  Many are today and there is no reason for me to have both.  Clearly if we have complex arrhythmias, requiring treatment (ablation, medication, pacemaker) an EP is the specialist we need to be seeing and the more experienced the EP the better for us.  But I know you already know this.  With arrhythmias I would ideally want both - a doctor specialising in both electrical and structural heart problems, since one problem can frequently lead to the other.  Not sure if that has helped but as you are well at the moment I would stay with the cardiologist who is more than capable of helping you

There will never be complete satisfaction wherever we go, will there?   I have just had to change my GP practice after 40 years Pharnowa because my hubby was unhappy with the treatment received from the Practice Nurse. Life is full of frustrations and people that we would rather not have to deal with, but I would choose the doctor you feel most comfortable with and it sounds as though it is your cardiologist Pharnowa.  He knows you best after all these years and you obviously trust and feel happy with him.  That is so important.  We can always tame that nurse of his in the future and she sounds as though she needs taming.  Under the cardiologist's care you have the opportunity of seeing the company rep once a year too.  What more could you ask for.

It sounds as though your cardiologist was just a little surprised to see you back after referring you on to an EP who he considered to be perhaps more appropriate to take over your care as you needed a pacemaker.  On re-reading your comment however, it seems your cardiologist thought you had transferred yourself permanently over to the EP according to your nurse, so no wonder he was somewhat puzzled and maybe that led to your feeling that he was less warm when you saw him this time.  It does though make me question which speciality you most need at present?  

As you know your cardiologist so well, I would write a brief letter confirming your desire to remain under his care, but only if he feels it is appropriate for you to still be under his care?  Explain to him in the letter you feel safe and happy with him, and apologising again for any misunderstanding caused by the nurse.  If you need the guidance of an EP in the future, he will be able to refer you back for advice/treatment at that time, but put it in writing so there will be no misunderstanding of your wishes. 

Good luck Pharnowa

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