Mentioning a possible diagnosis to your doctor?

[yello]

My doc's been trying to get a baseline on my blood pressure for a while now. Basically, it's all over the place. Sometimes hyper, sometimes normal. There is an element of 'white coat hypertension' (or 'blouse blanche' as it's called here) for sure. Plus, I have to speak in French with him and that adds it's own pressure/limitations. (Btw, many docs speak some, if not good, English. My doc speaks none; zero/zilch. That's an observation btw, not a complaint!)

I've been wearing a portable unit for the last 24 hours that takes my pressure every 20 - 30 minutes (so bugger all sleep last night!) in the hope that we can establish what my normal/average is... so we can then decide if/how to treat.

However, I know from my own readings that my BP is variable; I can get readings of 160/110 and then 135/80 some 2 minutes later. I have no idea how variable blood pressure is meant to be... so I googled it. I know, I know, google diagnosis!

BUT: I did come across a recent study (March 2010) that suggests that variable BP is as much a warning sign as constant or average hypertension.

My question: should I let my doc do his stuff (I mean, he IS the qualified one!) or should I say something? Mention that perhaps my variable BP could be cause for alarm in itself?

 

[Hacienda71]

You could ask him if he thinks it could be hypertension, then at least you are asking his opinion as the doctor rather than telling him how to do his job, that would let him consider it if he hadn't thought of it himself without losing face.

 

[yello]

I'm wondering whether perhaps he's thinking only along hypertension lines!

He's an excellent doc, I really like him. He's not one to go racing to the prescription pad (very unFrench of him!) which I both like and respect. I once went to his surgery only to find he was on holiday and the locum replacement told me categorically that if I were his patient, he'd prescribe BP meds there and then! My regular doc wants to be sure of any diagnosis and I appreciate that.

He's aware that I'm an anxious/nervy individual (I told him), and my BP is elevated when he takes it, so he's trying to ascertain whether or not it is hypertension by trying to find my 'real' BP. My fear (such that it is) is that he's not considering the variable nature of my BP as a symptom in itself. That I do sometimes have a BP well within clinical hypertension range (he took it once at 180/110!) is perhaps an issue, be it caused by anxiety or otherwise. Certainly the report I read suggested as much.

 

[Stephenite]

The last three times i've been to the doctor I have said "I believe I'm suffering from XXXX". They've then gone on to ask about the symptoms, carry out tests and make their own diagnosis. As a GP sees hundreds of people he/she is not going to be phased by what you say (as long as you're polite and respectful), but it may help them in their diagnosis.

Tell him what you, honestly, think. As the language is a little bit of a problem work out a sentence or so which precisely says what you want to say. Then you can be sure he's understood you.

Bonne chance

 

[overgeared]

GP's are just that, General Practitioners. they may have spent 5 years at med school, but they had to study a lot of stuff in that time. the chances are that if you spent a few hours on the internet researching a particular condition you would have a more targeted understanding then he and should not be afriad to explain what you know. remember you are the (paying) customer, if you want to suggest what the problem might be, and have the guy prove or disprove thing for your peace of mind, then that's your right.

 

[frank9755]

No harm in asking him specifically if he thinks the variable blood pressure is a concern or not. If you don't address it you won't get reassurance.

 

[ColinJ]

It's over 20 years since I've consulted a doctor and I wasn't impressed by the last one I spoke to.

He put me on antibiotics for the throat infection I'd gone in with and then asked me if I had any other problems ...

I mentioned that I thought I'd had hearing problems after perforating an ear drum when diving to the bottom of a deep swimming pool.

This rapidly degenerated into a lecture where he told me that my opinions were worthless, I was wrong, what I told him had happened, hadn't, and in fact couldn't have because there was no anatomical way for that to happen. How could water possibly get from inside an ear to the back of the throat?

I suggested that the Eustachian Tube would be an obvious candidate and he went loco - he'd studied so many years here, so many years there, under eminent so-and-so, at prestigious such-and-such ...

Exactly how many years had I studied anatomy for?

I said that it had only taken me about 10 seconds to find the diagram of the inner ear in an anatomy textbook and the Eustachian Tube was there for all to see, with a description of how it extended from the anterior wall of the middle ear to the lateral wall of the nasopharynx, approximately at the level of the inferior nasal concha.

He didn't like that one little bit ...

 

[brockers]

I think GPs are used to hearing diagnoses from their virtual colleague Dr Google, these days. I'd like to think that most of them are in the business to alleviate suffering, not to score points, so are willing to work with your reasons as to why you think you're suffering from X's syndrome. One advantage they do have, and something they're trained to do is a differential diagnosis - a process of systematically eliminating possible diagnoses which aren't spot on.

 

[yello]

You're all quite right of course. I should mention my thoughts, even if they be way off the mark! I'll just have to carefully construct my sentence in French before I go (not something I normally do, usually I just wing it!). I need to get a medical certificate anyway (need one to ride sportives here) so it can be a kind of 'on, by the way' type of conversation. He's a good bloke and apologises when he misunderstands me, so I know he's considerate of my position and makes it as easy as possible for me. I think Colin's experience with his doc was perhaps not the norm... I hope anyway!

I think GPs are used to hearing diagnoses from their virtual colleague Dr Google, these days. I'd like to think that most of them are in the business to alleviate suffering, not to score points, so are willing to work with your reasons as to why you think you're suffering from X's syndrome.

Yes, I think you're right. Even here, in backwater France, people use t'internet! Actually, the computer network here for doctors etc is brilliant. Whenever I have a blood test or whatever, the results get put on the network and he is made aware of them... and it's normally same day. That is, I'll have the blood drawn in the morning, it's sent to a lab and analysed and he'll have the results that evening. I get a copy in the post the following day.

That said, I haven't had the results from my 24 hour blood pressure test (the unit's called a MAPA - 'mesure ambulatoire de la pression artérielle' - here). I was half hoping they'd be in this morning's post but I guess it'll be tomorrow now. I'll have a look at those then phone for an appointment.

 

[Red Light]

[quote ="yello"] You're all quite right of course. I should mention my thoughts, even if they be way off the mark! I'll just have to carefully construct my sentence in French before I go (not something I normally do, usually I just wing it!).[/quote]

Try writing down what you want to say and then tell him as your French is not so hot, you've written down what you wanted to ask then hand it to him.

 

[Crackle]

Are you sure it's variable. It's quite easy to mess up a BP measure with a home device, which aren't so accurate. A friend of mine was very similiar to you. Even an impending visit to the GP would send his blood pressure racing. He too wore one of those devices for a period. In the end we managed to pack him off for a private consult with a consultant to discuss his fears. After a long consult and him explaining his history, his worries and an examination, the consultant told him he was fine, no medication necessary. His doctor wanted to stick him on BP tablets too and he didn't want them so in the end the consultant visit was a godsend.

Strikes me you're a fit bloke Yello and you'd know if something was causing you a problem, recognise some symptoms (have you?), so I'd be cautious too and wait for your GP to reach a proper diagnosis. Maybe suggest to him seeing a specialist but I'd not over concentrate on the differing readings if I were you.