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Letters |15 August 1995

Evaluation of Chest Pain in the Emergency Department

Frank N. Finkelstein

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TO THE EDITOR:
The authors of the recent editorial [1] do not support their allegation that without specialized testing, a cardiologist can sort out atypical and bizarre chest pain. Straightforward cases do not require the service or care of a cardiologist. The absence of an acute myocardial infarction does not rule out significant coronary artery disease. The natural history of coronary artery disease is that often, symptoms disappear during rest. Hence, patients who are not hospitalized or who are discharged early are not necessarily healthy. They may go home and have an infarction.
We appear to be competing to see how little care we can deliver and how much we can get away with. Although we can evaluate and stratify patients into low-risk groups, we cannot place them in zero-risk groups, nor can we predict from population statistics what an individual person will do. Consequently, we must bear the risk for death and litigation.
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Finkelstein FN. Evaluation of Chest Pain in the Emergency Department. Ann Intern Med. ;123:314–318. doi: 10.7326/0003-4819-123-4-199508150-00017

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Published: Ann Intern Med. 1995;123(4):314-318.

DOI: 10.7326/0003-4819-123-4-199508150-00017

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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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