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Heart failure

​Satisfaction with health professionals

Most people we spoke to felt they were well looked after and they thought their care was the best available. There were many expressions of gratitude to their health professionals for improving their condition or keeping them alive.
 

Brian cancelled his private health insurance because he regards the care he gets on the NHS as excellent.

Brian cancelled his private health insurance because he regards the care he gets on the NHS as excellent.

Age at interview: 76
Sex: Male
Age at diagnosis: 70
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I cancelled my health insurance a few years back because I’d always had private health cover when I was working and when I retired, I continued to pay for it myself but I never had needed one, I never used it because I only hit these problems in my sixties and I was immediately put on National Health treatment because with, whatever they say about the Health Service, if you have a, a serious health problem like a heart problem, you’re seen straight away and I found that it was just pointless retaining medical insurance so I just cancelled it and I’ve found that the treatment I’ve had under the National Health, both GP and hospitals, but also these ancillary things like the exercise, always excellent. Now what’s it like if you want a new hip or a new knee, I don’t know [laughs] but to me it’s been excellent. 
 

Ted felt that his health professionals must be doing something right because treatment had relieved his breathlessness.

Ted felt that his health professionals must be doing something right because treatment had relieved his breathlessness.

Age at interview: 78
Sex: Male
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Well, I think they’re doing quite well with it. I mean I’m going in once a month and they’re checking on various things. They obviously take a blood test. They must be able to take some from that. They take my blood pressure which, at the moment, is staying right. They check my weight. About once every couple of months they’ll do a check on the chest and my, and the back and everything, you know, sound it.  So yeah, as far as I’m concerned they’re doing what they think is right. I mean, whether it’s right or not I mean I can’t tell. I mean they’ve done, got away with the breathlessness. They’ve made me breathe easier so they must be doing something right. 
Health professionals were often praised by the people we spoke to. Those whose check-ups were provided by a specialist nurse, either at hospital or at home, greatly appreciated the care that they received. They valued the explanations that the nurse gave them of their condition and its treatment, their readiness to answer questions, the lifestyle advice they gave, booklets they sometimes supplied for keeping records of weight and fluid intake and information about what to do in an emergency. One man said that the heart failure nurses were ‘invaluable’ and ‘worth their weight in gold’. Daniel said he felt so well looked after that there was nothing more that could be done for him other than being allocated a nurse around the clock. His specialist nurse was only available during normal working hours but he found that a short conversation with her could relieve his frequent bouts of anxiety. (See ‘Specialist heart failure nurses’)
 
Cathleen had been delighted that her local pharmacy had delivered her medicines to her home when she was too ill to collect them herself. She also commented that the telephone appointment system at her GP’s surgery had advantages and disadvantages.
 

Cathleen wondered whether her anaemia had gone undiagnosed because the GP couldn’t see how pale she was during a telephone appointment.

Cathleen wondered whether her anaemia had gone undiagnosed because the GP couldn’t see how pale she was during a telephone appointment.

Age at interview: 88
Sex: Female
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They have this nice system now that you can’t necessarily see who you want straight away at the surgery, but if you, if you ask, one of the surgeons, one of the doctors will ring you up at the end of his surgery session and give you advice. And that I think is why I hadn’t had my anaemia diagnosed, because I’d been getting advice over the phone and nobody had noticed, and I hadn’t taken any notice of, how pale I had got. So these advances in, which feel very good when it happens, you don’t have to wait, have their bad side as well in a way. 
Continuity of care was seen as important, with some people saying they tried to always see the same GP about their heart condition whenever possible so they wouldn’t have to explain their history to a different doctor every time they went to an appointment.
 

Philip always sees the same GP about his heart so that the GP gets to know him and his condition and Philip doesn’t have to retell his story to different professionals.

Philip always sees the same GP about his heart so that the GP gets to know him and his condition and Philip doesn’t have to retell his story to different professionals.

Age at interview: 52
Sex: Male
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You’re confident that that that everyone you’re talking to knows your condition. They know you, because you’re only seeing the same people time after time. You’re not seeing different people, so it’s bits and pieces. So you’re very confident, so you’re not stressed out, which a lot of patients do get because they go and see another GP and it’s like, [sighs] ‘Oh it’s a different GP. I’ve got to tell them the same story.’ Before they’ve got in there they’re overly stressed. I see the same GP. I make that a total rule that if I’ve got a problem I will see the same GP for that problem. If I have a different problem, say, a rash on my arm, I’ll go and see one of the other GPs, if they’re available,  because I know it’s got nothing to do with my heart. If it’s got anything to do with my heart I will see the original GP. 
Seeing a specialist nurse also provided a level of continuity of care that was not always possible with GPs or medical specialists at hospital out-patient appointments. One man complained that he never saw the same GP twice and that all the GPs he had seen appeared poorly informed about cardiomyopathy—the cause of his heart failure—so he would always prefer to speak to a specialist nurse. Although some people said they saw the same consultant every time they went for a check-up, several others said that they rarely saw the same doctor and that doctors didn’t take the time to familiarise themselves with the person’s medical history. This had on occasion resulted in contradictory advice being given or inappropriate changes being made to medication. For instance a 35-year-old man developed hepatitis from taking Zocor (simvastatin) and digestive difficulties from atenolol that required invasive investigations and treatment, after which it took two years to stabilise his system, then another doctor who had not read his history tried to prescribe Zocor again (see ‘Other side effects of heart failure medication’).
 

Rarely seeing the same doctor twice has led to inappropriate changes of medication being suggested by doctors who don’t know the history of his heart failure.

Rarely seeing the same doctor twice has led to inappropriate changes of medication being suggested by doctors who don’t know the history of his heart failure.

Age at interview: 35
Sex: Male
Age at diagnosis: 35
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It was very, very disturbing when, you know, every time you see a new doctor who has no idea what did you have before, what sort of side-effects you had because of these medications. Because if, you know, instantly they say, ‘Oh you're not on Zocor and you should take Zocor,’ I say, ‘Doctor I can't take Zocor because I had a liver problem because of the Zocor,’ ‘Oh, then we should try this.’ And this is not tried, and I've tried 7 new medications and they affected my health tremendously, actually badly. If I was seen by one doctor from 1993, or at least three doctors from 1993 until now, I'm sure I would've, you know, none of this would've happened.
Another man said that each of the different hospital specialists he had seen, and his GP, seemed to have contradictory ideas about what medication he should be taking. His drug regimen had been changed so often that he was not surprised when things went wrong. An elderly woman changed her GP after another doctor advised her that she needed different medication from what the GP had prescribed. A woman in her fifties who had a cardiac resynchronisation therapy (CRT) device implanted was told conflicting information by different NHS staff about which hospital she should attend to have the device checked in the long term.
 
By contrast, others said that the specialists who looked after their different conditions communicated effectively with each other. A man who had developed liver and kidney problems and now had blood clots in one of his legs said that his various specialists were debating among themselves whether to increase his warfarin dose or discontinue it.
 

He says that the various doctors who care for his different health problems are discussing together what to do about his blood clots.

He says that the various doctors who care for his different health problems are discussing together what to do about his blood clots.

Age at interview: 62
Sex: Male
Age at diagnosis: 56
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And at the moment they’re all discussing, heart, liver, haematologists, they’re all discussing why I’m getting these clots and what they’re going to do about it, because one doesn’t want to keep me on warfarin because it is actually quite a dangerous drug, one has suggested we ought to up the warfarin level and take the risk of an internal bleed, etc. and on it goes. So my attitude is basically, look you chaps fight it out and I’ll go along with what the majority decision is. So that’s where we are at the moment.
Continuity of care can foster rapport between doctors and patients, and some people talked about having developed a good relationship with particular health professionals and how much they appreciated the care they had given them. Many people who had check-ups with their GPs were satisfied with the arrangement, feeling that GPs had listened to them, reassured them and made sure that they were regularly monitored. Others said they liked the fact that their GP held heart clinics or had a special interest in heart failure. Some people we talked with were being monitored by a GP who had particular expertise in heart problems. Brian has complete trust in his GP/heart specialist and he no longer sees the need to have private health insurance. Vivienne has complete trust in the competence of her GP/heart specialist. Although her initial symptoms had been dismissed by hospital staff as panic attacks, her GP had identified them as those of heart failure.
 

Vivienne’s feelings towards her GP/heart specialists are of gratitude and complete trust.

Vivienne’s feelings towards her GP/heart specialists are of gratitude and complete trust.

Age at interview: 61
Sex: Female
Age at diagnosis: 60
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I will be seeing Dr [name of GP] providing there’s no problems every three months. He’s been absolutely a rock for me. He’s been marvellous. He’s answered all my questions, he’s put me at ease, he diagnosed me straight away and he was there for me when nobody else was.

This is your GP?

Yes so I’m, I’m grateful. If it wasn’t for him, I don’t think I’d be here, I think with the doctors not picking it [heart failure] up at the hospital, you know. So I’m really grateful to him.
 

She goes to hospital every 3 months and sees her GP every 8 weeks mainly to talk about her concerns; he is a good listener.

She goes to hospital every 3 months and sees her GP every 8 weeks mainly to talk about her concerns; he is a good listener.

Age at interview: 66
Sex: Female
Age at diagnosis: 65
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I see my GP every 8 weeks now, really to sit and talk to and he's a brilliant listener, and that's set aside from hospital clinic visits. You can't do it without other people even if you think you can. 

How often are you going to the hospital clinic?

Every 3 months at the moment, but I do have a hot line if I'm in trouble, I can phone up this number or I can go through the GP so I'm not alone. But I feel I'm coping. I know there's going to be bad times, good times and bad times, it's all been explained to me. I do feel able to cope with it now, but it's taken me quite a few months to come to this decision.
Beth appreciated that she could discuss things frankly with her GP and disagree with him, and Philip referred to his GP as ‘the brains of the outfit’. A man who had the same GP for 25 years and sees him three times a year for his heart condition said that if he consults over some other health problem the GP takes a holistic view of him and checks up on his cardiovascular health at the same time.
 

He sees his GP quite often for problems unrelated to his heart but the GP takes the opportunity to check his blood pressure and his general well-being.

He sees his GP quite often for problems unrelated to his heart but the GP takes the opportunity to check his blood pressure and his general well-being.

Age at interview: 65
Sex: Male
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I can go at any time and quite often I will go for something other than anything to do with my current condition, i.e., I may have a sprained ankle or I’ve got an earache. Nine times out of ten, in fact, no, that is wrong, ten times out of ten, he will check my blood pressure at the same time and ask me how I am generally, as opposed to just the condition that I’ve gone to see him for. Yes he knows me personally. He has been my doctor now for 25 years, he should know me by now, and I think, and I know him.
As well as sticking with the same GP, a woman who had monthly home visits from a community heart failure nurse said it was always the same nurse who came and so they had developed a good relationship.
 
Building a relationship over time with a particular consultant was also valued. A man said he felt that the heart specialists he had dealt with treated him like a person not a number. A 49-year-old man who saw the same specialist repeatedly said he would never choose to move away from the area because he wouldn’t want to lose his current specialist, whom he valued for the way in which he explained his condition to him in simple language that he could understand.
 

He misses the cardiologist he had built up a relationship with over the years.

He misses the cardiologist he had built up a relationship with over the years.

Age at interview: 49
Sex: Male
Age at diagnosis: 46
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Yes, we're talking of personal situations now. In my own personal situation there has been a change which sadly had to come about. My cardiologist from day one in the UK who I had a wonderful rapport with, the one who decided that I perhaps didn't need the bypass initially - but I've never never ever held that as a grudge it was a decision and that's it, sadly has moved to another hospital. She knew me and knew me well and she knew when I was bluffing [laughs], she saw straight through me, she was great, I've the greatest admiration and respect for her and [was] deeply saddened to lose her because I felt she knew me and she knew my situation, and that is a tremendous comfort. The cardiologist I have now was a colleague of my former cardiologist (they worked together), no problems at all - different person, different mannerisms, different everything else, but an equally fine cardiologist I'm sure, but cardiology is one of the things she does whereas my former cardiologist was a cardiologist, this is a general consultant who does cardiology, and as such has inherited the former cardiologist's workload.

So with the greatest respect in the world to my present cardiologist, she really doesn't have the time to spend and to even get to know me like my former one did. It's not a criticism it's just a statement of fact. So I dearly miss my former cardiologist and do not have the facility with my present one that I had with my former. If I picked up the phone and rang her secretary and said, 'It's so and so here, can I have a word with Dr such-and-such?'. They would say, 'Oh yeah hello - (first name terms)', the secretary would say, 'Oh yes, I'll let her know you rang'. The secretary wouldn't ring me back, my cardiologist would ring me back and say, 'Hey up, what's the problem?' or 'Those drugs are doing that to you? I'll tell you what, do this, do that', and we'd talk, that was fantastic, anywhere anytime. Don't really have that with the present cardiologist to the point that now, where I used to see my former cardiologist every month, I see my present cardiologist every three months, and that's by choice.

Paula, whose heart failure is a result of congenital heart disease, has been seeing the same consultant for seventeen years, even though in that time she has moved 400 miles away from the hospital where he is based. They have a long-standing relationship based on trust and mutual respect, so she chooses to make the journey two or more times a year rather than seeing someone else. She has all necessary checks done while she is there, including her pacemaker download, and the consultant discusses her care with her local GP where necessary to ensure it is seamless.
 

Paula lives 400 miles away from her consultant but travels to see him twice a year because he treats her with respect and she trusts him to give her the best quality care.

Paula lives 400 miles away from her consultant but travels to see him twice a year because he treats her with respect and she trusts him to give her the best quality care.

Age at interview: 46
Sex: Female
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I mean the medical profession have been absolutely fantastic with me, I can’t fault them in any aspect. But on saying that, they are not always right and they don’t always know everything, so it, it’s got to be, I think you need a really good relationship with whoever you’re with, that they understand what you, you know, how you know yourself to how they know you. I do think that helps.

I travel four hundred miles to see my consultant. I won’t see anybody else unless my consultant says, you know, he’s away or whatever, you, somebody else is going to be seeing you, and that’s happy. The pacing team are exactly the same, I see the same consultant and they’re aware that, you know, I do travel that distance for a reason, because in my opinion that’s the place I get the best care, the best quality, I, my husband is informed with everything that’s going on, I’m treated like a human being, you know, it’s not a Mrs So-and-So, it’s first name terms. I know his wife’s name, I know his children’s names, I know what his kids do, what they want to do when they’re grown up. It’s a very very personalised relationship. 
Even where continuity was less of an issue the departure of a particular doctor from a hospital could upset established routines and damage the patient's confidence. One man explained that when his cardiologist left he preferred to transfer to his own GP for check-ups.
 
The quality of care depends on multiple factors. It was recognised that NHS staff might be overworked and couldn’t always give the time to patients that they would like to; one person said that 5 minute GP appointments were inadequate.
 

Beth was full of praise for her health professionals but recognised that they were overworked.

Beth was full of praise for her health professionals but recognised that they were overworked.

Age at interview: 57
Sex: Female
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I think they’re all pretty wonderful. I know they are all over worked and probably massive workloads, so there’s work related stress for all of the health professionals I’m involved with. I just think that they’re wonderful people doing a wonderful job, unfortunately they cannot give each patient a hundred percent, and are having to cut it down to maybe 97 percent per patient, which, like me, they probably feel like they’re not getting it all and but we don’t think of it from the doctor’s so there’s, whoever it is, the heart failure nurse practitioner, a nurse practitioner in the GP’s, we don't see it from their point of view because everything’s, it’s our little world and everything’s massive to us in our world and we should be taking priority but the reality is they might have 50 people feeling that they should be priority. And they are wonderful people doing a hard job. 
We heard accounts of different levels of care in different parts of the country. Norman moved area specifically to obtain what he saw as better care than where he lived previously. Paul found his care less to his satisfaction after moving to a different part of the country on his retirement; he didn’t see a cardiologist as often as before and had to remind staff when things needed doing.
 

After moving to a new area Paul feels less well supported by the professionals than before and has to remind them when tests are due.

After moving to a new area Paul feels less well supported by the professionals than before and has to remind them when tests are due.

Age at interview: 68
Sex: Male
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When I actually got to retirement age my wife and I decided to move to [town in different area] because that’s where her family is, so we, we moved down and I went to the local hospital, obviously, and got on, on their system, which as far as monitoring is concerned, personally I’m not too impressed with  what they do. I can’t really say I’ve got any complaints, but at the same time it’s, I don’t feel as well supported here as I did with the original hospital. I do find that I have to make the running. I’m the one who says, “Has this been done?” “Isn’t it about time that I had an echocardiogram?”, “Next blood test is due”, etcetera. It’s not coming from them. Also I was due to have my latest pacemaker change at the same time as I was due to go in for another major operation actually on my stomach, and the dates were likely to clash, and the two departments weren’t talking to each other, so they didn’t actually realise until I said about it that there may be a problem. And in fact on one occasion an echocardiogram that, appointment that I had been given fell through the floorboards and they’d just simply forgotten all about it. And again that was only through, through my contacting them that we managed to get it sorted. The actual monitoring, the actual tests that they do I’ve got no complaint with at all. The information is there and, and I do get the information eventually, and again though, I have to ask for it usually rather than them supplying it, so that’s about it really. 
Others also said they had prompted their GP to do particular checks, such as blood pressure or cholesterol, if they hadn’t been done for some time.
 
 

Her GP is reluctant to alter her medication and she has to remind him to check her blood pressure and thyroxine levels.

Her GP is reluctant to alter her medication and she has to remind him to check her blood pressure and thyroxine levels.

Age at interview: 69
Sex: Female
Age at diagnosis: 64
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For the actual medicines I'm taking, it's the cardiologist. The GP won't touch them or alter them at all. Now he is monitoring my blood levels every month and anything else that I want he would give me, except that with all the aches and whatever, pains I've got, most of them could be inflammation which I can't have any inflammatory tablets because they affect the kidneys.

Yes, it is up to myself... to generate and tell the GP that I think it's now time I had my blood pressure done again. And I'd like another blood test done for the thyroxine because I'm taking thyroxine and it's 12 months or 6 months since they did that.  Because although he takes the blood every month, he's only checking the creatinine and the urea which is from the kidneys and then the extra things I have to remind him [I] take. 'Please, I'll have my blood pressure done today', which is normally very low, fortunately, so that's why I keep taking the tablets. [smiles] 
 
 

Her GP is reluctant to alter her medication and she has to remind him to check her blood pressure and thyroxine levels.

Her GP is reluctant to alter her medication and she has to remind him to check her blood pressure and thyroxine levels.

Age at interview: 69
Sex: Female
Age at diagnosis: 64
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For the actual medicines I'm taking, it's the cardiologist. The GP won't touch them or alter them at all. Now he is monitoring my blood levels every month and anything else that I want he would give me, except that with all the aches and whatever, pains I've got, most of them could be inflammation which I can't have any inflammatory tablets because they affect the kidneys.

And what about blood pressure and weight changing and things like that?

The GP does that, yes, but I have to ask him. I say, ‘It’s about time we did this now, or can we have this done now?’ He’s very good but they don’t remember you all the time, so you just have to remind them.

So it’s up to you to generate … 

Yes, it is up to myself... to generate and tell the GP that I think it's now time I had my blood pressure done again. And I'd like another blood test done for the thyroxine because I'm taking thyroxine and it's 12 months or 6 months since they did that. Because although he takes the blood every month, he's only checking the creatinine and the urea which is from the kidneys and then the extra things I have to remind him [I] take. 'Please, I'll have my blood pressure done today', which is normally very low, fortunately, so that's why I keep taking the tablets [smiles].
Beth felt let down by her hospital when a follow-up appointment did not happen after she was discharged following treatment for a heart attack. As a result she had felt unsupported and had worried about things that could have been addressed by a hospital professional. Although she is checked regularly by her GP and practice nurse, she feels that these visits are not specific enough to her heart condition and she would prefer regular access to a cardiologist or specialist nurse.
 

An expected hospital appointment never happened causing Beth to worry about her heart; she would prefer checks with a hospital specialist to the general practice staff.

An expected hospital appointment never happened causing Beth to worry about her heart; she would prefer checks with a hospital specialist to the general practice staff.

Age at interview: 57
Sex: Female
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I think I needed general reassurance at that time, and I was told I would be given an appointment within six weeks, and I didn’t get that, and nobody seemed concerned that it hadn't happened. I think if I had have gotten that appointment at six weeks I wouldn’t have had any of the concern over the year. And that's all I would have needed, just someone reassuring me and saying, ‘Right, we’re going to monitor you, we’ll see you in a year’s time and see how you’re doing then with the view to possibly discharging you, all being well’. And I think I would have been quite happy with that, but it was that missed appointment that just continued over a long period of time causing more concern - why haven't I been seen yet, what's happening with my heart? And it was the uncertainty that the stents had worked. I was then very anaemic. Had they nicked an artery or something when they were doing the stents? And all these sorts of idiot thoughts going around in my head, which was - it was probably silly, I mean thinking back on it now it was probably silly but those thoughts were there at that time and I needed reassurance at that time, and it didn’t happen.

I think I would have been happier if I had a definite appointment with either a cardiologist or a heart failure nurse, which was specifically for me, you know, ten minutes or fifteen minutes time with me, even if it was just to reassure me. Whereas the clinic, I know it was, the clinic I attended in my GP’s, although it was a heart failure clinic, it seemed more of a general type thing, which is something they do routinely within the practice, and they invite everybody in, and I just felt it was more generalised rather than personalised support. And I think even just one appointment with the cardiologist would have kept me quite happy. And if I’d had a named nurse who I could have contacted if I was worried about anything, if I was concerned about having to use the [GTN] spray more often or anything I could have a quick phone call  to a heart failure nurse and she could have given me the reassurance I needed. 
Some people who were looked after in secondary care were reluctant to consult a GP about their heart failure because they seemed to lack expertise in it. A 35 year old man, who was under the regular care of a specialist cardiac nurse and had read a lot about his heart condition, believed that his GP knew less about heart disease than he did. Another said that the doctors treating him acknowledged that he knew about as much as they did about his condition.
 

He thinks his GP's knowledge of heart disease is very general.

He thinks his GP's knowledge of heart disease is very general.

Age at interview: 35
Sex: Male
Age at diagnosis: 35
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Well the role of the GP is very limited to be honest. They're very general, I mean their knowledge is very general. She knows that I, I think by now to be honest I know probably more information about the heart diseases than her because after I've, you know after what I've read, about you know about heart disease I think I'm more knowledgeable than her!

She was very general. She wouldn't say anything other than like, "Eat moderately, don't, avoid junk food and fatty food," which I know you know, she wouldn't add anything to my case, I mean she wouldn't add any benefits.

Actually I don't see her, I mean I don't, I'd go to see her if I had bad flu or you know something else other than the heart disease, because I know if I have a problem I know what to do myself now. 


There were some specific concerns about something people felt a particular professional had done or not done. This included delays in diagnosis or referral, and treatment decisions.
 

Anne was unhappy after her GP of many years had inaccurately recorded the duration of symptoms she presented to her and didn’t send her for tests.

Anne was unhappy after her GP of many years had inaccurately recorded the duration of symptoms she presented to her and didn’t send her for tests.

Age at interview: 73
Sex: Female
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I mean we’d been with our, the GP that I had then for over 20 years, and when she referred me she said things in the referral letter that were covering her tracks. And I was pretty appalled at that, so I wrote her a letter and put in what actually had happened. And I think, you know, the surgery were quite worried because she is a person… I mean she’s a very, very good GP. She’s absolutely super. She’s been absolutely marvellous to us and, but I thought, well, but she has in the past, she had in the past before this happened to me she has actually said that she’s rubbish at diagnosing. And so I thought, well she, she acknowledges the fact that she isn’t good. But when she put in this letter that I’d had breathlessness for a few months, when it was over a year, because I mean I didn’t go to her right at the beginning, you know, I thought, ‘Oh’, you know, ‘I’m unfit; I must get fitter’, as you do. You don’t rush, rush to GPs, and I said to her, ‘Why didn’t you send me for more tests?’ And her reply was, ‘You didn’t ask for them’. And I said, ‘But who’s the GP?’ No I didn’t. I said, ‘But I’m not the GP’ [sigh] I couldn’t believe it for an answer. 
 

Peter avoids one GP in his local practice after they suggested a treatment that Peter felt was inappropriate for him, prompting him to seek the opinion of his cardiologist.

Peter avoids one GP in his local practice after they suggested a treatment that Peter felt was inappropriate for him, prompting him to seek the opinion of his cardiologist.

Age at interview: 67
Sex: Male
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There’s been one GP who is supposedly a cardiac specialist within the practice, and I’m sure he is but his advice hasn’t always been of the best, and fortunately in one particular case I knew enough to turn down the medication he was offering and said I would rather have an opinion of, from the cardiac specialist at the local hospital, specialist hospital and to put that off until I got a view from them. And I just feel that his judgement is not always good, not for me anyway, at particular times, and it just shows you that how much specialist knowledge you need to be able to treat somebody like me who I know has had, even within cardiac disease, a fairly, a different route. I don’t think I’m, well, everybody is different of course, but I think my experience has been unusual in terms of heart disease and I feel that very few GPs would, would have enough knowledge to know where I’m at, and some could make big mistakes. Having said that, within the practice there are 9 or 10 GPs, and I’ve found one younger GP, who I think is maybe about 35, who actually guessed that I had heart failure, and therefore advised the, was taking it down two possible tracks and asked me to go for a blood test, which in fact showed up heart failure at about the time I was to have a cardioversion. So he made the correct judgement, and in fact the very young GP I saw 15 years ago guessed that I’d had an angina episode on holiday in New Zealand and sent me immediately for a treadmill test at one of our local hospitals where we lived before. And so their judgement has been, you know, they’ve spotted the conditions very well. It’s just that with one GP I have a problem, so I avoid that GP. 
Another man whose heart condition was monitored by a specialist nurse was reluctant to consult his GP unless absolutely necessary because the GP had upset him on a previous occasion by saying something insensitive.


Summary added in April 2016.
 
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