ECGs

 Many patients ask me for an ECG during a visit.  They feel it is part of "the annual check up."  They often say that other doctors use to do it routinely for them.

Like many medical tests, ECGs should only be done in response to a symptom or physical finding on an exam.  Chest pain, palpitations, fainting, hypertension - these are all legitimate reasons to obtain an ECG.  In these situations, it can help in diagnosis and management of a number of conditions. 

ECGs are terrible, though, used as a screening test.  A normal ECG does not exclude the presence of heart disease.  It may be reassuring to a patient to have a "normal" tracing, but when performed in the absence of a symptom such as chest pain or palpitations, it offers very little useful information.

Why do many doctors do ECGs?  It is an easy way to make money.  Medicare reimburses about $20 per ECG.  For something that takes about 2 minutes to perform and interpret, but has little utility in the routine setting, it can be lucrative.  

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