When It Is Time to Change Physicians

When Is It Time to Change Physicians is my question — and one for which I have at least one answer…..

There are lots of reasons people change physicians. The patient moves to a different location. Their doctor retires. Their doctor does not accept their insurance. The doctor doesn’t give the advice one wants to hear.

There is another reason — one that explains why I am leaving — firing — my cardiologist. Because I may report him to the state medical authorities or sue, I will keep his name out of this essay. The reason for the firing: he is rude, disrespectful and committed malpractice or at least something akin to that. Arrogance is bad too.

Perhaps others can learn from this story. I get that I am disclosing some personal medical information — but nothing too revelatory by today’s world standards.

Let me begin by saying I am not a kid. I am recently on Medicare. My father was a cardiologist. For real. I am an educator — a former tenured law professor. I am healthy, not obese and I exercise. I don’t smoke; I get tipsy from one glass of wine (a recent phenomena). A glass of wine several times of week is good, apparently, for your health. I have normal blood pressure and no diabetes. My biological father lived til 82. My biological mother is alive at 93. Grandparents on both sides, minus one, lived into their 80’s and 90’s. I don’t have heart disease or atrial fibrilation.

I do have “bad” cholesterol numbers. One number is too high but improving; one number is too low but improving. I take a baby aspirin daily. I tried statins (different ones) but they all made my joints ache, especially my hips. Ache. That was not a placebo or nocebo effect by the by. Oh, my risk of heart disease, measured in blood work, is in the normal range.

Recently, I went to the cardiologist in question. I have well under 20% plaque in my arteries based on the test given (so low they do not even measure percentages apparently) and it is not progressing at a high rate. Seems it has stayed virtually flat (“mild increase”) since 2017. The actual word used by this physician is “mild.” As I read the results, some plaque in some areas has diminished while some has slightly increased but I’m no pro at reading these results to be sure. My EKG is normal.

His comments to me were plentiful but I cite four things he said because they are the cause for this essay. All are exact words to the best of my recollection.

1. “You are a stroke waiting to happen.”

2. “I do not want to take care of you if you have a stroke you could have prevented.”

3. “Your hips hurt anyways, what’s a little more pain?”

4. “You’ve probably had small strokes already which would be visible on a brain scan.”

I am not making this up. Seriously.

So, being an academic, I can do research and do have more knowledge than this physician acknowledges. First, whether one is at risk for a stroke is multifactoral. You don’t need medical school to learn that. Cholesterol levels are not the sole determinant of a stroke risk.

Second, the benefits of statins and their link to stroke prevention and death are not clear cut and there is not uniform agreement that statins are so wonderful for everyone. Some are questioning their overuse and their being an “easy” solution.

Third, pain is not something one needs to have in many instances and saying I have pain anyway, why complain, is ridiculous. My orthopedist has controlled and continues to control my IT band pain and why I would invite hip pain beats me. By the by, he is remarkably decent and understanding. My hip joints are fine; it was the statins that brought pain. And that pain is not controlled by the orthopedist.

Fourth, looking at the percentages and numbers, there are risk calculators for strokes and heart attacks. These are plentiful in number and some are more than a tad flawed, especially for women and there are differing algorithms in different calculators. They measure a point in time and they do not account for future changes of a positive or negative nature. The impact of natural healthcare approaches isn’t even on the radar.

I have determined that, using several different measures and calculators, that we are all at risk of a stroke eventually. Sure, we all die. Best as I can calculate (forget that not keen on death related topics), I have less than a 10% chance of a stroke in the next ten years. It is below the average and does not apparently warrant even a baby aspirin (which I do take). Without statins that is. With statins, my risk of a stroke and heart events is lowered. My risk is lowered if my cholesterol numbers improve.

So, assuming you can annualize risk, which seems like the numbers would increase over the ten years as one ages but let’s keep them even, I have an estimated under one percent risk of a stroke this year. Were the numbers “perfect”, the risk would be lowered and my personal risk would be .25 — .50 or so. My math may not be spot on but I am not that far off. For an annual difference of .5 percent or even less of increased risk, why would I take statins, which hurt me, prevent exercise, present their own risks and aren’t always medically sanctioned? Who knows, they might increase risks of other problems, which a better calculator or different risk measure might show. Indeed, statins affect glucose levels and the liver. What one really needs to compare is the alternative risks of statins for me vs. stroke or a cardiac incident.

I would not say, then, that I am a stroke waiting to happen. Or if I am, so are we all. Every one of us. We have a risk of stroke or heart disease. But, it is not as if the likelihood is 20% or 30% this year. I am not a walking disaster. I have not looked at risks of flying or driving or crossing a street lately but we face that percentage daily.

Now, if I have had mini strokes, so have many people. Indeed, brain scans would show most of us as we age have brain changes. But the brain is plastic and recent literature shows it can bypass or compensate for changes through workarounds. That’s key. In other words, the physicians threat misses the point: all of our brains change and we’d need to ferret out why there is diminished capacity, if any.

But the worst statement of this physician does not need research: I don’t want to take care of you if you get sick. Basically he said, it is selfish of me (the doctor) but I don’t want a call in the night that you (the patient) stroked out.

Seriously.

So, here’s my take: this physician needs to lose his license. Or, stated another way, he is a danger to patients. In short, he is a cardiologist without a heart. How ironic is that?

I think we need to speak up and out and take action when we are mistreated. We get scared and we listen to authority. This time, the scare tactics, rudeness and complete absence of decency and medical accuracy took me over the edge. Way over. And I need to share the story so others are not similarly treated.

I know this physician went out on his own with his wife into their own practice because the prior practice did not want him. She’s absolutely terrific by the by — and overweight and non-alarmist and pleasant and responsive and decent and smart smart smart. My source is good and unlikely to lie.

I’ll find another doctor and I don’t plan on taking statins or stroking out anytime soon. But I am firing my cardiologist because he gives bad and incomplete advice and gives his profession a bad name. To his credit, he empowered me to do research and act. That’s not bad. In fact, I feel quite empowered and healthy.