A Tale of Two Offices
This was one of those days that I dread … dread … dread. I not only had one doctor’s appointment, I had two. I’m a little bashful about being too “out there” with this sort of thing, but I have such wise readers, that I thought I may be able to glean a bit of advice from both sides of the medical fence - those in the profession, and those who may be able to relate to a bit of what I’m experiencing …
Those of you who are long time readers probably know that I have a bit of a panic problem when I find myself nose to nose with someone in a white coat … or who could be wearing a white coat, if he isn’t. It kept me from seeing a physician all but once in 16 years … until about 3 years ago, when I was diagnosed with kidney failure, severe hypertension … and other secondary problems. For about 2 years afterward, I sometimes wondered why I bothered going home - I was in one office or another … or one hospital or another … so darn often.
Anyway, over the last year I’ve distanced myself as much as possible from the situation. That’s been both good and bad, as you might imagine. I’ve continued to see my nephrologist every four months, but went for more than a year without seeing my PCP … until his office called me late this spring and wanted me to make an appointment to come in. Reluctantly, I did. To make a long story short, they found that my blood pressure was elevated enough for concern (over 200 systolic) … and had me coming in to have it checked repeatedly. Always high.
Well, something very revealing happened today … something I’ve suspected for a long time now.
This was the day I had to see my nephrologist. He took my blood pressure standing and sitting, and it was great! Sitting was under 150 systolic, standing was super! Although I’m not comfortable enough to be really open with him, he’s a quiet fellow, and the 4 month visits with him are pretty stress free. I know what he’s going to do … I know what he’s going to say. There aren’t any surprises. He’s pretty laid back. We even exchanged a bit of small talk about the direction primary care seems to be taking.
I had a few hours between that appointment, and my next one … so I came home, relaxed, and did some school work, then headed back out the door. Once there, his nurse came out to get me, brought me into the exam room, and took my blood pressure first thing. That’s what I was there for - again. The systolic was 178. Not really all that high, but much higher than it had been all day. I looked at her, shook my head and said: “Robin, it’s this office. I just can’t come into this office.” I told her about my visit to the nephrologist earlier in the day. She went and spoke to my PCP, and to my amazement (and relief,) I was out the door in about 5 minutes. I guess they didn’t want to be responsible for a stroke … *cough* …
Now, I like my PCP. I’ve liked him since I first met him. This may not be the problem, but his style is vastly different from the nephrologist’s style: my PCP is a bit “fidgety,” and usually has a string of rapid fire questions that I’m not well prepared to answer. I find it completely impossible to just chat with him, although I can say practically anything I want to him by email, or on paper, and have in the past. I’m certain that if I met this fellow outside of his profession, that I would really like him a lot, and see him as a fun, humorous sort of person to be around. In this setting however, I’m at sea.
Today proved it to me. My poor PCP gives me HTN!
I know that the elevated HTN is from some sort of emotional/psychological reaction - otherwise it makes no sense. But I have absolutely no idea what it could be - or why. It appears that just stepping through the door causes it to rise a good 20 to 30 points, if not more. The first time I ever went there, it was 280/160 … although I admit there were more medical reasons for that sort of reaction back then.
Now, this old lady isn’t getting any younger, and I’ve got ongoing problems that I just sit on because the thought of going in to see him makes me so nervous. Even when things get so bad that I give in and go, we get nowhere because I can’t express myself. My fault - not my PCP’s … and that part, at least, would be a problem anywhere I went.
So … my wise readers … what would you do? Would you try to stick it out and work on it? If so - how? I’m all ears! Would you look for someone else? No guarantee that I’ll do any better anyplace else, though … and I’m not good in that venue even under the best of circumstances. Also, having to start over with someone new would be stressful in itself.
Depending on the advice you all give me, I may cut and paste this post and the replies into an email …
A Long Search:
- A Tale of Two Offices
- Testing the Waters
- On a Rollercoaster …
- And the Ride Goes On
July 18th, 2006 at 10:14 pm
I have no wise advice … except … I wonder if it could be his equipment ..do you have your own b/p machine? If he has an abnormally high number of patients with high b/p …it might be them.
I do understand though … I go to the GI doctor and my blood pressure is always sky high. He was livid that my doctor wasn’t treating my high b/p. When I tried to tell him that I only had it in HIS office, he didn’t believe me …he was so upset, he called my PCP to see if he could start me on something. Then she confirmed … I have (uh hem … had) low blood pressure.
So then he came in and asked me if I had it with any other doctor … I told him …only if they’re a GI doc … which perplexed him. By this time, I’d had time to figure it out.
YOU GI DOCTOR’S STICK CAMERA’S WHERE CAMERA’S DON’T BELONG!!!
he laughed. Examined me, talked ..and ordered a camera down the esophogus into the tummy …. see???????
Now. … my blood pressure is high …all of it’s own accord and for no good reason.
Maybe next time I go back into GI the Toprol will keep my b/p down to a reasonable level.
July 18th, 2006 at 10:14 pm
Wait a sec, let me take my white coat off first. You know I like my white coat a lot.
Here’s my question: Is it going to be more stressful to stick it out with this person or trying to find a new PCP? If this is the only PCP for 200 miles, well then you may be stuck. But, if there is someone else just across town, I think it may be worth it to just start over.
I don’t think it’s the situation, meaning all PCPs are bad. I think that it’s just this guy. Sometimes for whatever reason, personalities don’t mesh. I see this all the time. I’m in a multiple doctor practice and when I’m on call for our office I cross-cover for the other docs. I’ve seen instances when people are glad to see the “nice doc on call for the office,” and others don’t like seeing the “young doc on call for the office.”
Forgive the soapbox, but you and your PCP should be on the same side on things - working together - not playing hide and seek. You know that HTN can lead to other complications. Your PCP should be your advocate and not your advasary.
*Dr Anon climbing off soapbox slowly*
Hope my rambling doesn’t confuse you more. Feel free to e-mail me to discuss further.
July 18th, 2006 at 11:12 pm
Moof, you don’t know me, but I sort of know you through my daughter’s blog. Amka, aka the granola, is my baby girl who has grown up to become an amazing woman.
I have a similar problem with doctors. Here is my suggestion to you. Since you have no problem emailing your doctor, could you write to him about your problem before you go in? Then he would know what the problem is before you see him. Alternatively, and I have done this, write out what it is you want to tell him. Then give him the paper to look over. Don’t try to read it yourself….if you are like me you will leave off the parts that are difficult or embarrassing to you.
If you do decide to find a different doc, be prepared for it to take a while. It took me a couple of years after we moved to different state to find an md that i was compatable with.
Good luck!
July 18th, 2006 at 11:51 pm
Pk … I should have known you’d be the first person over here, you little angel.
Sorry to hear about your high blood pressure! Hopefully the Toprol does work … however, if it works when you’re not at the GI doc, it may not be adequate for when you are at the GI doc … 0.o
I have 3 BP meds, and one of them I’m supposed to take more of depending on what my BP is at the time. If your problem is bad enough, maybe you can talk to your doc about a sliding scale like that for you …
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Dr. Anon … thank you very much for removing that white coat! *shudders!*
About my PCP, I didn’t express myself well. I don’t think of him as my adversary. When other physicians’ offices have messed up calling in medications, or done some really egregious “dropping the ball” … he’s been right there to clean up the mess. I honestly do not understand why I react to the poor man that way. It’s truly unfair all the way around.
There are lots of other docs around - this is a highly medical area. But … how on earth do you go about choosing someone?
“Hi! Let me just sit here for a spell and see if you kill my blood pressure!” *cringe*
And Dr. Anon … please be careful with those soap boxes! Sometimes they’re slippery! You wouldn’t want to fall and break anything. Well, on second thought, if you did fall and break something … you’d have more time to blog, wouldn’t you? >;o)
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Rinda … thanks for the comment! Wow! Did you ever hit home! What you’ve described is exactly what I’ve been doing. I’ve emailed him, and I’ve written things out and handed them to him. But oooh! The horrible discomfort and anxiety of sitting there while he reads them! *ack!*
Whenever I’ve read things out loud, I’ve skipped over exactly the things I shouldn’t have skipped - just like you said. It’s rather a relief to know that I’m not the only one with “terminal panic attacks” at doc’s offices.
The problem with all of that writing, and so on, is it wasn’t enough. Left to my own devices, I just stop going because it’s so much effort.
Your advice regarding finding a new doc is pretty scary … because I see something like that happening so easily. I’d like to make it work with the one I already know … but … Dr. Anon had a lot of good points too. I’m not sure which will be more stressful … trying to make it work with this one, or finding a new one … *blink!*
July 19th, 2006 at 1:59 am
Salut Moof:
I would like to start by offering you some science. White coat hypertension is a matter of debate among doctors. While it is true that patients get nervous seeing doctors, they get nervous in other situations also. Some of us (myself included) think that if your pressure is EVER over 200 in the office it probably happens at other times besides the doctor’s office.
Also, studies that correlate blood pressure with stroke risk are based on office pressure measurements. In other words, the pressures your doctor is getting may be more indicative of your health risk than any pressure you might get at home.
I am very aggressive about treating hypertension. Overall, though, I am not an aggressive doctor. It is just that I know A-plus evidence when I see it, and the evidence that your pressure should never be over 140 even in a doctor’s office is pretty strong.
All of which is to say that the pressures you have admitted to are unacceptable. Whether you like your PCP or not you owe it to yourself to find someone who can help you regulate it. I am not a stickler for office visits — often I will allow a patient to call in with BP measurements and will make adjustments over the phone. Or I will let the patient come in for a BP check only — no doctor — to see if things are different when I am not around.
I would recommend at least trying a new PCP. You might ask your nephrologist. Or, if you know someone who works at the local hospital ask them which doctors they enjoy working with the most. Nurses have to interact with doctors all the time, and they know which ones have good people skills.
If you see a new doctor, tell that doctor that you find appointments anxiety-provoking and ask him if he can help you with that. A doctor who has a good answer to that question is the doctor you want to keep.
I wish I could help you more but I am in Mississippi. Keep in mind that getting that systolic below 140 at all times is the ultimate goal and if a doctor won’t keep working with you to meet that goal you have the wrong doctor.
Good luck, God bless, and try some deep breathing in the meantime.
July 19th, 2006 at 3:20 am
This is a tough one. I love my PCP, but I can’t seem to get all my doctors talking to each other. HTN can be a real pain, but I found it just doesn’t go away without treament. If you have your own BP cuff I would recomend mointoring yourself. Mointor when you are stressed, calm , and unsure. These reading will help you give the doctors an more accurate picture of what is going on. You HTN needs to be control and your doctors communicating to each other and you. Now I’m starting to ramble, but the bottom line is take care of yourself at all cost.
July 19th, 2006 at 8:16 am
Moof……..It is essential to the patient primary care interaction that you can communicate well. If this doesn’t happen then you are being short changed…period! If it is just an issue of HTN then let your nephrologist manage your HTN (he/she is trained to do that afterall) and let your PCP do everything else. On the other had if this dificulty affects your discussing new and other problems than if I were you I would make a change. I have an opening at 3:40 today…what do you say (lol!)!
July 19th, 2006 at 9:02 am
Hi Moof,
I am sure you have heard all about “white coat induced hypertension”. Whether this PCP wears a white coat or not, I would imagine that if your comfort level is…err…subpar with this particular physician, you could have a rise in your BP. That being said, I would be a tad concerned that your blood pressure is THAT high from an office visit. I certainly don’t claim to be an expert in hypertension, but I remember a bit from being an RN. If it were me, and I didn’t have a sufficent level of comfort with my PCP, I might seek a “second opinion” from another doctor. It is nothing personal against the doc you already see, but if it isn’t the right fit for you, it might be time to make a change.
July 19th, 2006 at 10:52 am
Bonjour Dr. Hebert! Thanks for dropping in and leaving me such a helpful comment!
You brought up a few things I hadn’t already thought about … for example, talking to those who work with the physicians for information on which physicians have the best “people skills” … and just seeing what sort of reaction I might get from a new person if I were to admit to having a problem with that sort of interaction to begin with.
I just hate to leave someone I already know … and like, no less … you know?
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Wanda! Thanks for dropping in, and for taking the time to leave me a comment!
Yes, I do already take my own BP at home … and have since all of this began. It can go from a nice cool 140/80 to 220/90 in a few hours … depending on what’s going on. I guess it’s my “barometer!” *LOL*
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Dr. Grumet … wow! I read your comment, and got an immediate panic attack! *LOL* My bad!
Seriously though, from what I’ve seen over at your blog, if you were local, I would definitely take you up on that appointment …
And yes, you’ve hit the nail on the head … it does, indeed, get in the way of “discussing new and other problems,” and that’s where my greatest concerns are with passing time. At my age, things come up - and they’re not all CRF and HTN related.
Now, where did you say your office was? ;o)
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Pattie my friend! Thank you for dropping in, and for your fine advice! I laughed out loud when I read the ” … err … subpar” part. I love your humor!
You’re right, I have nothing personal against the fellow I’m seeing, in fact I’m quite fond of him … and since I know the problem resides with me, not with him, I keep second guessing myself when it comes to whether I should move on. You know … there’s the idea that if the problems resides with yourself, that you’re going to just drag it along with you wherever you go.
I’ve been sitting on this one for a few years now … and yesterday proved to me that I need to make a decision.
July 19th, 2006 at 7:42 pm
By now you’re probably sick of getting advice from docs and non-docs. All the comments have been wise and caring. Please follow the advice of your many friends. Buy your own sphygmomanometer, a cheapy simple one for $15 to $20 if you must, or an electronic one for $40 to $70 (if the prices have not changed just recently).
Once you’ve done it, get into the habit of checking your BP every single morning for the rest of your life! In addition to that, check it once or twice a week at different times: dinner time, when you’re tired or angry, or when all’s well in the world!
Then, once a month (depending on the results), show your list to your doc.
July 19th, 2006 at 7:48 pm
umm I love my PCP as you have noted from some of my comments and I will say don’t second guess yourself… even if you like the doc outside of the office…IT DOSN’T MATTER… what matters is that you are comfortable with him/her inside the office. I am glad that this doc has picked up the slack when others have messed up. If your really adverse to changing docs I would recomened a sit down with him in his office not the examining room. maybe after all the other patients have been seen… after hours another words.. and talk to him about what you are uncomfortable with in his style of questions and such… if you can’t work around the problem that way then i strongly recomend finding a new doc. Most will (at least in my area) meet with you and let you talk with them and see if your personalties mesh like the do with a pediactric pt. With the health problems you have it is not only important that you find a doc who does well but one you can “connect with well” i don’t believe your doc would be offended more like he would be relieved that you are getting yourself taken care of. If he is as good as you say i bet a fancy dinner he would understand, and possilbe recomend another doc with a personality you might click better with.
Good luck
hugs
July 19th, 2006 at 10:28 pm
Hmmmmm, I’d go to Dr. Grumet! Seriously though, I have the same problem, Moof. I can write letters and emails, but sit me in the exam room, and I clam up. Try writing him a letter or email beforehand–it can’t hurt. If that doesn’t work, then you can move on to Dr. Grumet . . . ;o)
July 19th, 2006 at 11:47 pm
Dr. Engel … I’ll never be sick of getting advice. After all, I asked for it!
I’ve had a sphygmo for years, but don’t often think about using it. It’s a simple one - the electronic ones don’t work well with me when my BP is too high. They just don’t register anything at all.
About taking my BP each morning … I’m not making any promises there. About 3 weeks ago, I was told to take it twice a day … and I remembered to do it all of 8 times total in the entire three weeks. It’s not the foremost thing on my mind, although I guess it probably should be in some ways.
Dr. Engel … do you take your ownBP every single morning? You’ve got even more medical problems than I do! *poke!* ;o)
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Woflbaby … that was really some very insightful, excellent advice! Thank you for taking the time to comment again! I really appreciate it.
Now … about that fancy dinner … >;o)
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Trickle … I’d go to Dr. Grumet too … in a heartbeat! *LOL*
Really makes me wish my local people were bloggers - I’d have a clue of what they’re really like beyond the name on their office doors.
Dear heart, I think that each of us in our own way, you and I are both “Difficult Patients.”
I was looking forward to hearing from you, because I had a feeling that you would be able to relate to all of that.
Thanks for taking the time to comment. I appreciate it! {{{ hugs! }}}
July 20th, 2006 at 3:25 pm
i agree with jordan and that you need to feel comfortable and be able to communicate with your PCP easily. i usually pretend they are someone else. like a girlfriend that i would spill anything to. my PCP thinks i have a bad case of TMI (too much information) :)
July 20th, 2006 at 7:35 pm
taking a bp every day???? that would drive me insane! I keep thinking I’m going to go buy myself one …but I don’t.
July 20th, 2006 at 8:48 pm
Hi, Moof. I’ve been lurking for a while, reading you since you popped up on so many of the blogs I enjoy with insightful comments. My family has a history of labile hypertension (where BP’s can jump tens of points in just a short time). In combination with that, my mom has White Coat Hypertension (WCT)…and she loves her PCP. However, for her, even the thought of having a BP taken can make her BP jump many points. She has a home sphgymo, an electric one, and has to put it on, sit quietly and, at some point when she’s relaxed, my dad punches the button. Her BP is always normal that way. But in the MD office, she can range from normal to very hypertensive. I had labile HTN too, although since I lost a lot of weight my BP has returned to normal and I was able to stop my meds (yeah!) But, I could go from my “normal” of 110/70 to 180/105 in 5 minutes if the stress level was right…and my previous boss was good at making sure it could happen…thank goodness I don’t work for her any more.
Good luck controlling your BP. It’s hard, but worth it. I felt so much better when it was under control, even before I lost the weight.
July 20th, 2006 at 10:09 pm
Hi Moof, I have been reading and learning as much as you from this post. I would change pcp’s. Like you I also take 3 bp meds a day although I don’t recall ever having a reading as high as that one you just admitted to. I have to admit Moof it’s an illness I have never understood. I was put on BP meds when I was 20 yrs. old and pregnant with my first child. Over the years someone occasionally comes along that thinks they would like to discontinue my meds, just to see how I do. That’s happened 3 times and 3 times I ended up in the er with horrible nose hemmorhages and having 72 in of gauze shoved up my nose for 36 hours. This attitude on the part of the PCPs worried me.
I have to agree Moof, that you BP isn’t controlled or it would not be rising to those levels under any circumstances. That’s mainly why I think you need a new PCP. I currently take demadex, hyzaar, and toprol XL. That seems to be a good mix for me. I haven’t strayed, to very high numbers, much since being on this combination.
Is this a family history thing Moof? My mom had HBP for all the years of my life as did both her parents. Like me my mom was first put on meds while pregnant with me. My grandmother died after suffering a stroke and my grandfather had a cerebral hemmorhage.
Bottom line Moof, you have to find a dr. that doesn’t make you nervous and that you are comfortable with. You aren’t with this guy.
July 20th, 2006 at 10:41 pm
Kt … I laughed myself silly reading your comment. TMI indeed! *LOL* For myself, even my girlfriends can’t accuse me of TMI … I began practicing something that approaches more than politeness on my adult children beginning less than a year ago. TMI won’t be a problem coming from me for a very long time yet, I think!
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Pk … wouldn’t hurt … you know that, right? *Poke!*
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Dawn … thanks for stopping in and taking the time to comment … and thank you even more for what you’ve shared!
I hear you about stress being able to make a BP jump to unbelievable levels in mere minutes - that’s exactly the way mine is. And I can usually tell when it’s happening.
And you’re right … you feel “so much better” when things are going normally, and your BP isn’t elevated. Good luck in keeping it at a nice, low level! :o)
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Cathy, I was just coming from reading your blog when your comment hit my inbox!
It sounds like your BP is worse than mine - I’ve never had uncontrolled nose bleeds, or anything like that with my problem. *comfort!!!*
You and I have a few meds in common - I was also taking Toprol (metoprolol) … but I dropped it on my own in the beginning because of the awful side effects. I’m still taking Hyzaar (100/25), so we have that in common. I also take Clonidine .2 twice a day, and Norvasc 5, once a day, and an extra one PRN when my systolic is above 160.
About family stuff … my dad had HTN, and died of a massive stroke. My maternal grandmother also died from a stroke, but I was too young to know what her medical problems consisted of … I would say that yes, it runs in my family - on both sides. The CRF is not genetic though.
You have great advice, Cathy. Thank you so much for sharing all of that, and taking the time to write it all out. You have no idea how much I appreciate it.
{{{ hugs! }}}
July 21st, 2006 at 2:08 am
Hi Moof,
Thanks for the email. I haven’t been shut down by my government… yet ;)
I agree with the four other doctors who have commented before me… you need to seriously consider changing your PCP, and you need to be more serious about controlling your BP.
During the course of your ‘one office or another…. one hospital or another’ initial evaluation of your hypertension, did you ever get a 24-hour ambulatory blood pressure monitoring done?
It might be helpful… your nephrologist may be able to identify situations which make your BP shoot up..
Lifestyle modification plays a major role in the control of BP…
And finally
Get some good advice, by that I mean from docs like Hebert, Anon & Grumet, who are involved in the day-to-day care of patients, rather than people like me :)
July 21st, 2006 at 2:48 am
Yes Moof, I see that we were each visiting the other at the exact same time. I think we are connected!…:)
July 21st, 2006 at 5:29 am
Dr. Scan Man! Thank you for coming and leaving me a comment! I’m awfully happy that you haven’t been “shut down” by the government! Latest news is that those who have are getting their web sites back!
Never got that “24 hour” ambulatory test you mentioned … but I think I know when it “shoots up” … when there’s a lot of stress. Hey! That would apply to anyone, eh?
Your last paragraph cracked me up! I was just beginning to wonder why you went into Radiology! You and the lovely Mrs. Scan Man should consider opening an office together! You sound like you’d make a great PCP! :o)
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Cathy … that’s a riot. It was the second time yesterday too. Kt and I also “exchanged visits” … what are the odds? ;o)
July 21st, 2006 at 12:26 pm
Hell, even I get nervous at the doctor! How much more so a normal person!
best,
Flea
July 21st, 2006 at 4:21 pm
But Dr. Flea! I though you were a “normal person!” >;o)
July 22nd, 2006 at 2:38 am
I get variable readings also. When I had day surgery recently they took my blood pressure and it was low. I just laughed as it had not been that low at home or at my Dr. office. I think that machines need to be calibrated and some medical personnel need their hearing examined. You said the nurse checked your BP did the Dr. check it also and get the same result?
I can’t say whether you should change your PCP or not. If you like him and he is good but you don’t go see him then he isn’t doing you any good. Would you change your behavior with a different doctor and go visit them?
July 23rd, 2006 at 8:12 am
Julie, thank you for dropping in and leaving me a comment!
My BP is consistently high. In fact, when it hovers below 120 systolic for any reason, I have to move very cautiously … that’s pretty rare though!
You made a very good point: “If you like him and he is good but you don’t go see him then he isn’t doing you any good.” There’s no way to know if things would be different with another person …
The “jury” is still out on this one … *LOL*
March 26th, 2007 at 10:07 pm
[...] Last summer, I wrote a post - A Tale of Two Offices - in which I asked all of my blog friends on both sides of the medical fence for advice on what to do about a PCP that quite literally gave me hypertension. I received a load of great advice from so many of you … [...]