confused about meds

i'm currently taking BB--atenolol, CCB---verapamil and warfarin
My electro cardiologist wants me to drop the CCB and start on propafenone, so i went and got a 2nd opinion from a general cardiologist who suggested drop the BB and go on propafenone . So now what?? I'm so totally confused ;)


5 Comments

Unnecessarily cynical

by Cycledoc - 2008-08-26 10:08:45

ElectricFrank your comment seems quite cynical and a bit off the mark. While physicians are targeted by drug companies the "benefits" are not quite as obvious as the carrot floating in front of the rabbit. Give a little credit for competance and ethical behavior to these guys/gals and understand that differences in prescribing is likely an honest difference in opinion based on experience and training (most of which by the way comes from reading, and meetings rather than company propaganda).

Your point about basing treatment change on one reading is well taken but that was not indicated in Karma's note.

What's Karma to do? Magster's suggestion sounds fine or simply go with the doc with the best local reputation.

Confussion

by joy1 - 2008-08-26 12:08:24

Hi karma,

My two cents...~smiling~ I think nearly all of us have run into the problem of mixed communication from our doctors. I actually had one of my first cardiologists tell me they are so specialized now that they can't even treat regular illnesses or problems and that's what your primary care doc is for. OK, if that's the way they operate then you...YOU need to put together a team of doctors where your primary doctor plays quarterback. You need a primary care doctor You can talk to, who listens to you, and who you trust to talk and coordinate care with the other doctors.

I have a good team of doctors now but even their communication got mixed up. One doctor thought the other doctors were taking care of me and around the circle it went. Just recently my EP and general cadio both thought the other was managing my care and my PC thought they were taking care of me.It all came to a head when I needed a refill on one of of the more specialized cardio drugs and she didn't feel competent to fill it. That's when the cat jumped out of the proverbial bag. Everything is straightened out now. Sadly for me that means I have to start doing all the cardio testing stuff again but hey, I'm receiving the care I need.

It is possible to put together a good team. Good luck karma. Let us know your trials and prayerfully success story.

joy

Confused

by ElectricFrank - 2008-08-26 12:08:45

This is easy to understand. Each of these doctors are visited by drub company salesmen who have access to their prescribing practices. It seems almost unbelievable, but the drug companies set quota's for various drugs that if met give the docs valuable perks. They are also the main source of training on the use of the various drugs.

So even though your 2 docs are in the same practice, they may be in a different situation as far as making goals and this affects their prescribing decisions.

The other issue with BP meds which gives them wide latitude in prescribing is that BP can vary widely from office visit to office visit. While basing BP treatment on one office reading is very poor practice it is so commonly done that it is rarely questioned( except by people like me). Then the resulting light headedness from hypotension is treated by another drug. And on and on we go.

frank

A good consumer

by Cycledoc - 2008-08-27 03:08:21

I hear you. Being a good consumer is a necessary part of our health care non-system. I certainly agree that if a patient is uncomfortable with any doctor's decision self education and another opinion is in order. However, painting with abroad brush that docs in general are under the influence is way wrong the great majority of the time.

Pushing new expensive drugs and technology to physicians and patients is of course how drug companies make there money. In my specialty costs/year for new drugs can exceed $100,000/year for the drug alone--more than the median and average incomes in the U.S. Interestingly most of these drugs have very limited benefit, yet it's what patients (and docs) often choose. Is this sustainable? Is the cost worth it? Who decides?

The question is how do we in a "free" society control the corruption and excesses. I'm pretty cynical about our health care and favor significant changes that would remove the inherent conflicts of interest, promote more rational use of technology and also hopefully decrease the distrust that such conflicts engender.

I occasionally blog at www.medicynic.com.

update

by karma - 2008-08-27 08:08:08

thanks for all the (i must say) interesting comments :)

well i took a chance and started on the propafenone and the CCB and presto ended up in emerg with my heart feeling like it was jumping out of my chest, SOB, and elevated BP --- so the moral of my story--if it aint broke dont fix it. I'm now back to where i started on BB and CCB
and for the most part i feel good except for the occasional Afib which i've decided to live with rather then ending up in emerg every time a doc decides to change my meds

You know you're wired when...

You have a dymo-powered bike.

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