Neurology: Hand tremors and Propranolol usage
in Health ·
copperrider59 said:My father is 74 years old. Over three years ago, he consulted a neurologist regarding a tremor in his hand. That tremor has persisted ever since, and quite frankly, it seems to be worsening.
I am currently uncertain as to whether an official diagnosis has actually been established. However, due to a suspicion of an underlying neurological condition, my neurologist has referred me for further diagnostic testing—most likely involving an MRI and a color Doppler scan.
He likely never bothered with those tests in the first place. Most probably, his primary care physician simply told him, "There's no point in running these diagnostics; whatever the results show, I'm going to prescribe the exact same medication anyway—it's all essentially the same."
And he was prescribed Propranolol.
Is it irresponsible for a physician to forgo ordering additional diagnostic tests, or would pursuing those investigations independently be a prudent course of action?
My father was taking his medication for a while, but he eventually decided to stop on his own initiative. His reasoning? He read the patient information leaflet and became convinced that the drug could pose serious risks to both his heart and his lungs. Given that he is a smoker and already struggles with COPD, he felt it wasn't worth the potential danger.
When a patient informs his doctor that he has discontinued his medication based solely on some research he read online, the physician supposedly responded with nothing more than: "I have no objections."
Is the fear of medication side effects actually justified? If we determine that the risk is indeed disproportionate to the benefit, should the logical conclusion be to abandon treatment entirely, or should we instead pivot toward finding an alternative pharmaceutical option?
I suspect that if he fails to address this neurological condition, the health consequences could be quite severe. In my amateur estimation, the only logical course of action would be to undergo a comprehensive diagnostic workup first. Only after obtaining such a diagnosis—and carefully weighing it against his entire medical profile—should a decision be made regarding which medication is appropriate to prescribe.
I appreciate your insights in advance.
This approach toward patient care is nothing short of irresponsible. Specifically, when you consider that your primary care physician prescribed Propranolol despite being fully aware of your father’s history with COPD—a condition where such a prescription is strictly contraindicated. Furthermore, I find myself questioning why the physician would even consider prescribing Propranolol without conducting any preliminary diagnostic testing. While I am not suggesting an immediate referral for a CT scan or an MRI, surely a basic physical examination and standard laboratory workups should have been performed? Such tests are essential to validate or refute a patient's claims within the scope of what clinical diagnostics can actually offer for these types of conditions. One must remember that a tremor is almost never the root cause; rather, it is a symptom of an underlying pathology. This could range from simple glucose metabolism issues or hyperthyroidism to far more severe neurological conditions involving damage to the peripheral or central nervous systems.
With all due respect to primary care physicians, the treatment plans prescribed by a specialist are often entirely disconnected from what a family doctor might suggest. If a neurologist suspects a specific underlying condition, those diagnostic tests must be performed—regardless of whether the family physician disagrees or thinks they are unnecessary. You have to consider the reality of medical documentation: there is likely no written record of the family doctor's initial recommendations. Therefore, if a serious condition actually exists and was missed because you bypassed the specialist's orders, you will find yourself in an impossible position. How exactly do you intend to hold a doctor liable? Every single medical entry serves both a clinical and a legal purpose; you cannot simply ignore the specialist's findings and expect to have any recourse later.
After reviewing the entirety of this discussion, I find myself questioning why your father even bothered consulting with a general practitioner in the first place. If a specialist has already reached a definitive conclusion regarding necessary diagnostic procedures, what purpose does a primary care visit serve? It seems redundant. Regarding the Propranolol, you must consider the broader clinical picture. Provided that all potential underlying pathologies causing the tremor are ruled out, Propranolol remains the gold standard. However, given your father’s specific contraindications, one should realistically explore alternative beta-blockers that might be more appropriate for his physiology. Furthermore—and I say this with the utmost respect for your father—his age is a significant factor. At his stage of life, the development of essential tremor without an identifiable cause is a very real possibility. This is something that warrants serious consideration in your deliberations. Best regards.