Can you ask GP what was put in a hospital referral?

[123bradybunch]

I have been unwell for a while, a few hospital admissions for severe asthma attacks and pneumonia.

I went to the gp about 6 weeks, as I am having episodes of low heart rate, dizziness, fainting and palpitations. This also coincides with my Fitbit acknowledging low heart rate which I told the GP.

I was referred to cardiology and have received a letter which states “I would simply
encourage her to continue leading a normal active and independent life and try
not to worry about report of slow heart rate from her smart watch”

I feel that the GP has completely dismissed the symptoms I have been having. Can a patient see what has been put in a referral letter?

Yes. You have a right to see everything they write about you.

Do you have the NHS app? My last few referrals are on there, under the 'documents' section.

Thanks I shall take a look and see

Of course you can. Do you have the online service? You can view everything on there. If you haven’t just ask you GP receptionist to sign you up

To be fair, if the GP has referred to cardiology they haven’t dismissed you. They could have said don’t worry about your watch there and then in your appt if they wanted to dismiss you. It sounds more likely the cardiologist feels you don’t meet the threshold for investigation. I think there is more of a move now for secondary care to advise GPs rather than see every patient themselves.
Fainting doesn’t sound great though. If that carries on despite decent diet/nutrition I would head back to your GP. (Caveat I am not clinical, just been in NHS a while.)

Yes this. Also so many referrals lately for ‘my smart watch said this’

As others have said, it's probably available on the app to view. But I have seen hugely detailed referrals come back with similar rejections more and more often recently. It's becoming harder and harder to get people accepted by secondary care, advice is offered instead.

Thank you everyone. I do have the nhs app but there isn’t anything under documents. I have contacted the admin at my surgery to request this is added.

it's quite likely to have been an online proforma that they fill in for the referral rather than a letter so may not be so easily visible on the app. Cardiology clinics are snowed under with referrals for people who have smart watches that are just picking up normal physiology (heart rates are supposed to fluctuate quite widely) or not picking up anything sensible at all (depends a bit if it's just picking up a rate or is actually recording a dysrhythmia... mine just picks up a rate and it's a complete fiction half the time). It doesn't always need an appointment and their advice in the reply is their medical opinion.

I have 2 diagnosed heart conditions, serious ones at that. which include arrhythmias that are fast. (Long QT syndrome and SVT)

my Apple Watch shows slow heart rates that aren't really there. I have a device in my chest that reveals the actual heart rate and there's no episodes of bradycardia.

it's worth noting in a referral that you've come in with slow heart rates in an 'Apple watch' as there's a huge chance that it's not really happening. My cardiologist said if you have a slipped beat which can feel like a little pause, it will register as a slow heart rate on the watch.

you need to manually take your BPM. Don't take too much notice of an Apple Watch and don't end up becoming obsessed with checking it.

Thanks everyone. I didn’t add that the gp said I was diagnosed with sinus bradycardia a few years ago but I have never been told this.

My heart rate drops down to around 45-46 so not horrendously low. I think with the dizziness and fainting I just want to get it checked out.

A few years ago I fainted at the top of the stairs and fell half way down and fractured a bone in my foot. They put this down to heat at the time as it was summer.

I have had fainting and dizzy episodes over the last year and it’s been put down to the medication I am on for my respiratory issues.

I had issues with high blood pressure after I gave birth around 4 years ago. I was put on beta blockers at the time. When I have had admissions into hospital my blood pressure has increased again (likely due to infection), the gp tried to put me on beta blockers again. Another gp said not to take them

Thanks everyone the surgery have done the request. I have attached what was put in the referral letter

I'd have been frustrated to see that the letter only mentioned the apple watch data as a symptom. Are the dizziness, fainting and palpitations being investigated by any other route? I think it would be reasonable to ask for a new referral with all symptoms listed.

Hope things will improve for you soon.

‘Panicking’. Ffs. What next, ‘hysterical woman’?

Whatever happened to neutral phraseology like ‘expressing concern’?

Yes - this is similar to what the gp said about my aunt the week before she was fitted with a pacemaker as an emergency. In contrast my brother with similar symptoms was very carefully treated - but in his case, nothing of concern

It should be mentioning the fainting which is not normal at all. I mean you broke a bone as a consequence. It could be even more terrible if you did so while driving or walking across a busy road. Or just if you were alone and were knocked unconscious on the floor.

That to me is the main symptom that is worrying.

That would annoy me. They’ve not mentioned the dizziness or the fainting.

In general cardiology hate smart watches.

I'm not surprised they turned down the referral however if you haven't even had a new ECG.

Cardiology would expect primary care investigations to be completed before someone was referred to them.

I almost died due to the 999 call handler refusing to send an ambulance. It was obvious they thought I was having a fit of the vapours.
The senior nurse on the CCU told me that if I had been a man describing the same symptoms, an ambulance would have been sent immediately.
It is never ending.

I'd be pissed off by the wording though - panicking about a smart watch reading is not what you presented with.

However cardiology would definitely reject the referral even properly written without evidence of some investigation first.

Panicking is bit off
Sinus brachial cardia does fit with your symptoms

the symptoms are more likely to be caused by something other than a sinus brady, esp if the rate's only into the 40s. Bloods and a baseline ECG would usually be the starting point before referring to cardiology though (literally no point seeing a cardiologist if you're anaemic....or hypothyroid...or generally a bit deconditioned after what sounds like a rough year with illnesses, or any of the other billion and one things that can cause dizziness). Might be best to get the bloods and ECG and take things from there again.