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).
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.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Kachalia A, Mello MM. Defensive Medicine—Legally Necessary but Ethically Wrong? Inpatient Stress Testing for Chest Pain in Low-Risk Patients. JAMA Intern Med. 2013;173(12):1056–1057. doi:10.1001/jamainternmed.2013.7293
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: