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June 24, 2013

Defensive Medicine—Legally Necessary but Ethically Wrong?Inpatient Stress Testing for Chest Pain in Low-Risk Patients

Author Affiliations

Author Affiliations: Harvard Medical School and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (Dr Kachalia); and Department of Health Policy and Management, the Harvard School of Public Health, Boston (Dr Mello).

JAMA Intern Med. 2013;173(12):1056-1057. doi:10.1001/jamainternmed.2013.7293

Ms Perry is a 58-year-old woman who presents to the emergency department with nonexertional substernal chest pain. She has no shortness of breath or other worrisome symptoms. The pain has been intermittent over several years, and last year, findings of treadmill stress testing for the identical symptoms were negative for ischemia.

The resident physician talks with Ms Perry's primary care physician and reviews her records. Judging by her history and presentation, the resident considers Ms Perry to be at very low risk for cardiac ischemia. Consequently, he believes that she does not need further evaluation. The emergency department attending, however, recommends overnight observation and nuclear stress testing. “She may not need it, but treadmill stress tests aren't always accurate, and being wrong is not the worth the risk of getting sued,” she remarks. Ms Perry is admitted; test findings are negative; and she is discharged home.

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