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The Medical Professionalism Blog

My EKG

I rarely get sick and have no known disease. I’m fit as a fiddle for an aging male. I jog four times a week and have strong vital signs (blood pressure is 120/70). I have no family history of heart disease.

Besides complying with adult screening recommendations and vaccines, I only see a doctor when I have a persistent cold or sore throat.  I fear going to a doctor because the standard operating procedure in my area is to provide antibiotics before the results of a throat culture.

The last time I went to my doctor, I was concerned about a persistent cold I had after traveling to Asia. I was worried that I had picked up an exotic parasite or SARs infection.  As I lay on the exam table, my primary care physician of over two decades said I should have an EKG.  As a good and conscientious consumer, I questioned why. He replied that he needed to get a baseline test.  Too sick and too tried to fight back, I reluctantly agreed to the test.

Since then I have learned that a baseline EKG yields little useful clinical information. In fact, the National Alliance of Physicians (NPA) — under a grant from the ABIM Foundation’s Putting the Charter Into Practice program — cites EKGs as tests that should be eliminated for asymptotic adults without a family history. EKGs were actually one of the NPA’s Five Things physicians should eliminate from their practice to improve quality and reduce costs.

This same primary care physician told another patient — and friend of mine — to have a stress test because he felt a woman turning 60 should have one. The findings from her stress test were not conclusive so he scheduled a cardiac catheterization. The results of the procedure showed no abnormality. However, my friend was left with an aching leg and a skin rash.

I have since sought a new primary care physician. It’s hard to break up with your physician but at least in this divorce no legal counsel was needed. My new physician knew of my previous physician’s propensity to overtreat – she had previously been in a practice with him.

In light of my unnecessary test, I am following the advice of Rosemary Gibson, author of Treatment Trap. Gibson suggests that clinicians and health professionals tell stories of care they received that were unnecessary, wasteful and the where the risks exceeded the benefits of the test or procedure.

Here’s mine. I hope you’ll share yours.

4 Comments to My EKG

  • March 30, 2011 at 7:52 am | Permalink

    Thanks for sharing your story, Daniel. I feel better knowing that even as knowlegeable and strong willed “consumer” as you, got hustled into doing something that you suspected wasn’t worthwhile.

    I think my own story was substantially more foolish on my part. When my wife was pregnant with our second child at 38 we got hustled into an amnio and a full genetic/chromosome screening. No effort was made to inquire what decisions we might want to make or be willing to make based on the results in advance. We then got the worst possible news – an unknown non-centrosomal chromosomal inversion. (A segment of DNA jumped from one chromosome to another and migh have either broken in the middle of something important or been inserted in the middle of something important.) While some such abnormalities have names and characteristic phenotypic expressions, the vast majority are unknown, offer no useable information and are therefore worthless.

    It was a clear case of the ability to “do” something driving its being done. Oddly, the insurance company was happy to pay. The genetic “counselor” seemed a bit embarassed, but mostly by how unimpressed we were with the basic genetics lecture. And we were out of our minds with worry for several weeks.

    Our son was born healthy (as far as we can tel yet). We have never found any use for the information about his inversion. After the fact, we realized that we would be unwilling to take any action based on such results and therefore we did not have the test done on our third child three years later.

    I think it is Studs Terkel who said, It is very hard to for a man to understand something when his livelihood depends upon not understanding.

    • Daniel Wolfson's Gravatar Daniel Wolfson
      March 30, 2011 at 10:42 am | Permalink

      Chris, thanks for sharing your story. It’s difficult to “just say no” in situations concerning your health or the health of your family. It makes sharing these kinds of experiences all the more important.

      - Daniel

  • Linda Bergthold's Gravatar Linda Bergthold
    March 31, 2011 at 11:49 am | Permalink

    Great piece, Daniel. I don’t have any particular stories of overtreatment (other than that stress test you mentioned) and am lucky to have a physician initially trained at Kaiser so she is prudent and conservative about what she recommends. Jessie Gruman retweeted this piece today in her twitter feed so I hope lots of folks see it and listen to your story!

  • April 4, 2011 at 11:15 am | Permalink

    Daniel, I applaud your sharing the experiences of overtreatment. It’s a great way to stimulate a needed dialogue on a topic that can be hard to talk about. Overtreatment becomes more than a “dot” or “rate” on the Dartmouth Atlas.

    My two favorite questions these days are:

    1. Have you ever had medical care you thought was unnecessary?

    2. Have you ever declined a treatment recommendation because it was too intensive/invasive and looked for a medically appropriate alternative?

    When I ask groups or audiences these questions, a minimum of 30 percent of people raise their hands. In one meeting of clinicians working in patient safety, it was 80 percent. Remarkable.

    You and the ABIM Foundation deserve accolades for launching this conversation that I bet will be the beginning of a needed transformation.

  1. By on July 11, 2011 at 8:50 am

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