This doctor makes over $200,000 per year to tell patients to go look things up on the internet
April 11, 2010 4:20 PM   Subscribe

Can sinus arrhythmia be dangerous? My doctor told me to ask you instead of her.

Last month, I had to have a complete physical before being allowed to play a sport at my college. I don't have any health insurance so the only place I could do it was at the student health center. The physical included an EKG. There was a two week wait for the appointment, and then another two week wait before I could come back for the results.

When I came back for the results, a nurse was there to give them to me and explain them. On my EKG there was a note: "sinus arrhythmia." I asked the nurse what that meant. The nurse told me she wasn't qualified to interpret something like that for me, and I would have to come back again and make an appointment with M.D. on staff. I agreed to do that.

Yet again the soonest available appointment was two weeks later. I arrived early for the appointment, and the M.D. told me she only had 5 minutes for me, even though it was still half an hour before they closed and there were no other people waiting.

I told her my EKG had a note that said "sinus arrhythmia" and that I was there to ask her what that was. She said "it means: normal." I was surprised. If it meant "normal" why not just write "normal" on the chart instead of "sinus arrhythmia?"

I said, "all right, but I'm still wondering what it is." She said "look it up on the internet."

I left the room stunned. I guess we are supposed to go to doctors to learn about medical things instead of learning about it from the internet, unless the doctor has somewhere else to be, and then the internet is just as good. So, I did what she said and looked it up on the internet. As expected, there was a wealth of completely conflicting information. I am most concerned about the information that says sinus arrhythmias should be treated unless they become worse and kill you.

I do not the doctor will be any more informative if I make another appointment, wait another two weeks, and go back to her with the conflicting information I found on the internet. I don't have health insurance or extra money to go ask another doctor. My professor overheard me talking about this after it happened and said she probably just couldn't remember what it was, and winged it because she felt like she was on the spot.

She told me herself to go find out what this is on the internet, so I'm asking you. Mainly I want to know if it is dangerous or could become dangerous. I've always played sports but I should know if playing sports will aggravate this arrhythmia.
posted by anonymous to Health & Fitness (16 answers total) 1 user marked this as a favorite
You need to name & shame this doctor. I'm sorry, but no licensed medical professional should ever tell one of their patients to "look it up on the internet."
posted by schmod at 4:25 PM on April 11, 2010 [14 favorites]

Well, your doctor was terrible.

However, sinus arrythmia is one of the normal variations of the heart beat. It just means that the pace of your heart is responding to the slight change in thoracic pressure as you breathe. As you breathe in, your heart speeds up a tiny bit. As you breath out the rate slows a little. (Or the other way around: it's been a long time since EKG class.) It is most often seen when the heart rate is slow, in athletes, or if the person is relaxed or sleeping. So don't worry about it.
posted by SLC Mom at 4:36 PM on April 11, 2010

First, I think you have an asshole for a physician. That being said, if at all possible change physicians from here out.

Second, you need to file a complain about this physician. I'm in the medical field, and am appaled at how you were treated. Call your insurance company and let them know what happened. State the facts. Tell them you want to open a complaint. Consider filing a complaint with the state licensing board.

Third, the "nurse" was right. Even though R.N. aren't the norm in dr's offices, usually they are Medical Assistants.

You might want to talk with the office manager and let them know you'll be sending a sports physical form for her to sign stating you are safe to play. I'd do this *before* you call the various places to complain.
posted by 6:1 at 4:36 PM on April 11, 2010

This web site is reliable, from the American Heart Association:

That first paragraph there is about sinus arrhythmia.

From Dorland's Medical Dictionary (which I own because I am a medical transcriptionist. I happen to type for a group of cardiologists, too. :-):

sinus rhythm: normal heart rhythm originating in the sinoatrial node.

sinus arrhythmia: the physiologic cyclic variation in heart rate related to vagal impulses to the sinoatrial node, which can be linked to or independent of the phases of respiration (see phasic a. and nonphasic a.). It is common, particularly in children, and is not considered abnormal.

physiologic: normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological.

pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology.

I hope that is helpful in interpreting the note on your EKG, but obviously you already know that this is not a substitute for an actual doctor answering your question. Though obviously the actual doctor you encountered in this case was a @#%#@(@#(!! :P
posted by AllieTessKipp at 4:44 PM on April 11, 2010 [1 favorite]

I'm a small town vet, not an MD, but I can tell you that in dogs (and I believe in humans), it is NOT dangerous. Basically, when you inhale, the pressure in your chest increases and your heart beats slightly faster. When you exhale, the opposite happens and it beats slightly slower. It's not really a problem, just something that we see on the ECG. Sports shouldn't be a problem, I actually see it more often in very athletic dogs.

/Interestingly enough, it doesn't seem to happen in cats.

//IANYD (unless you can bark really loudly) so you should get a new MD and put "sinus arrhythmia noted on previous ECG" on your medical history form.

/// If I took her attitude, I'd probably be run out of town.
posted by slightly ridiculous at 4:44 PM on April 11, 2010 [5 favorites]

6:1, it sounds like this was a doctor at the student health center, seen because the OP doesn't have insurance. Not that they shouldn't still complain, but they should go about it a different way.
posted by MadamM at 4:45 PM on April 11, 2010

I would complain to the university about this. Student health services are notoriously bad and I'm positive that the reason they get away with it is because the population they serve isn't in the habit of filing complaints. If this doctor was this awful with you, she will do it to other people.

Sorry I'm not able to provide info about arrhythmia. I'm just completely ticked off on your behalf. This is ridiculous.
posted by corey flood at 4:49 PM on April 11, 2010 [3 favorites]

6:1, it sounds like this was a doctor at the student health center, seen because the OP doesn't have insurance. Not that they shouldn't still complain, but they should go about it a different way.

I stand corrected, thanks. I'd complain to your coach and suggest where they feel you should go with the complaint. You can still complain to the state in which your physician is licensed.
posted by 6:1 at 4:55 PM on April 11, 2010

hrm. I think that sinus arrhythmia is a bit of a misleading term, because there is respiratory sinus arrhythmia, which is the definition given from Dorland's above, and then there is sinus arrhythmia, which is caused by irregular function of the sinoatrial node of the heart. (link is to national library of medicine Medical Subject Headings, which the the database that I work on).

Now, bc your doctor (asshole that she is) said that it's normal, it's very most likely the first, right? But you really should clarify.
posted by gaspode at 4:57 PM on April 11, 2010

A normal heart will have a spike pattern called sinus arrhythmia, apparently.

I am not a doctor and do not even play one on the internet. But apparently, that's the technical term for 'normal' when it comes to EKGs. The wikipedia article about sinus arrythmia looks distinctly unhelpful, but otherwise the internets suggest that it's a good pattern to have, if it's most common in young people and athletes. So you've spent two weeks being worried about something that turns out not to be a problem after all? You can relax. Breathe. Go play sports, yeah, it's fine, and much better than having worried about something which did turn out to be serious. The doctor you saw sounds really very unhelpful and maybe worth writing a letter of complaint to the medical center about, if you still feel that way in the morning. If the nurse who gave you your results was supposed to explain them but said she wasn't qualified to do so, that's some bad management going on there; the fault is unlikely to be with the nurse, unless she failed to follow procedure, but somewhere in the system.

Seriously, it may take you a few days to get used to not having a heart condition again, if you've had two weeks of thinking there's something wrong. And as someone said above, get all the paperwork sorted for your sports physical before putting in the complaint about the doctor.
posted by Lebannen at 4:58 PM on April 11, 2010

My husband is a cardiologist at a hospital. They semi-frequently see referrals from the student health services for this very thing--sinus arrhythmia in college students who come for their sport physical. He once ranted to me about this, because it's a complete waste of time for him to have to consult on these. This alone is normal, and the gp should know that.

Your student health services doctor is an ass and I hope you complain to her supervisor.
posted by emkelley at 5:23 PM on April 11, 2010 [2 favorites]

on preview: nthing the above.
IANAD/IANYD: Unless there was another finding, sinus arrhythmia by itself is not an abnormal finding. Hopefully, your entire student health center staff isn't as shoddy as this physician. Usually, student health centers employ internists/GPs, and she definitely should have been able to explain a sinus arrhythmia. At the very least, she should have given a brief description and pointed you to an appropriate online resource. In student health clinics, the physicians assume a fairly internet-savvy patient population, and because of time constraints, usually do send their patients to online resources for general information regarding normal findings - unless it is a condition that requires physician follow-up or chronic disease management.

For some obscure conditions, especially in an educated population like college students, the patient will know more than the physician, and the physician will usually admit their limited knowledge of the area/brush past it, or in some, respond in a snarky way. The other possibility could be that this is a locum tenens physician with limited experience with this type of patient population. Perhaps it was an off day for the physician, and what would have been a helpful description and direction to a helpful online resource came out as a cold and terse statement?

There could be a number of different reasons for your experience, but definitely try to find out who the better physicians are in your student health clinic because even at my health clinic, there is a huge disparity in diagnostic ability between the physicians.
posted by palionex at 6:14 PM on April 11, 2010

I usually defend doctors because I think they have to take a lot of shit from patients, but your doctor was being BEYOND ridiculous. If it happened exactly as you said, you should report her. She should have actually just been available to discuss this stuff over the phone. Her response was completely unprofessional, and you should write a note to the medical board or the head of her practice or hopital or your insurance company advising them. That's ridiculous.
posted by anniecat at 6:26 PM on April 11, 2010

Oh, I see you went to your college health center. I don't know then. I can't think of why she should act in a different way to a student than to a regular patient. The doctor at my alma mater was always very nice, even though I was convinced at one time that I was fatally ill and cried my eyes out to the nurse, even though I was actually just being really emotional.
posted by anniecat at 6:31 PM on April 11, 2010

On the matter of the doctor's behavior; If I were in your shoes I would file a complaint with the clinic and the hospital the clinic is associated with. If they do not resolve the matter, I would take the complaint against the doctor up with the state medical board.

On a more useful note, my medical research almost always starts with the Merck Home Health Manual followed by the Merck Manual of Diagnosis and Therapy. The former is intended for the layperson and the later is much more medical jargon filled but generally understandable if you follow enough of the links defining things. I have found I can have better conversations with my Doctors and they are always happy that I come in with specific questions seeking clarification.
posted by fief at 7:02 PM on April 11, 2010

While I agree with everyone that your doctor's behavior sucked, I'm kind of suprised by the level of outrage here because her behavior strikes me as pretty average. Most doctors I encounter act pretty much like this and I am always surprised and pleased when I run into a doctor who takes her time with me, shares information freely and does not patronize.

There are enormous pressures on doctors to be as fast as possible, I'm sure that's worse in many student health clinic type settings, and medical education does not, speaking generally, embrace an ideology about the importance of patient empowerment and knowledge.

Anyhow, good for you for doing your own research which I think would be wise even if your doc had been more helpful and forthcoming.

posted by serazin at 7:41 PM on April 11, 2010 [2 favorites]

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