Further Thoughts on Diagnosing Noncardiac Chest Pain
Since writing my essay on noncardiac chest pain," I have had responses from 2 physicians who agreed with the thoughts I expressed and 2 physicians who disagreed with them.
The point I tried to make was a simple one. Mainly, the physician who performs coronary arteriography needs to remember that patients and referring doctors are seeking help -- they want a diagnosis. And although I agree that it is useful for the arteriographer to state that the patient has noncardiac chest pain, noncardiac chest pain itself is not a diagnosis. Nor is it satisfactory for the arteriographer to say it is the referring doctor's responsibility to identify the exact cause of the chest pain after he or she indicates that the patient has noncardiac chest pain. Surely arteriographers are sufficiently concerned about solving the patient's problem that they are willing to share their views about the cause of the pain with the referring physician. Surely, arteriographers, who see many patients with chest pain, are interested in the noncardiac causes of chest pain. If they are not, they are giving up their role as doctors and have become technicians, whether or not they recognize their transformation.
There are many causes of "chest pain." Some of them are disabling; many of them are treatable if diagnosed. One of the physicians who reviewed my essay indicated that patients were relieved to know that they had noncardiac chest pain because they were reassured they would not be disabled and that their longevity would not be altered. He forgot to mention that many such patients continue to be miserable, making frequent visits to doctors' offices and emergency rooms, and that some of them are indeed disabled.
Also, the assumption that noncardiac chest pain is not serious is not correct. Even gastroesophageal reflux disease (GERD) may be serious: If persistent and untreated over a long period of time, it may be responsible for Barrett's esophagus.
I must confess, what bothers me the most about the designation of noncardiac chest pain by arteriographers is that it suggests that doctors are not required to make diagnoses and that telling patients what they don't have is considered to be "good enough." Coronary arteriographers have their boards in internal medicine and cardiology. Surely, as cardiologists, they are interested in all of the causes of chest pain that might mistakenly be construed as some form of coronary artery disease. I view with alarm the tendency for a cardiologist to function as a technician. If they choose to function as technicians, one wonders whether, in the future, non-MDs will be trained to do the test.
Since writing my essay on noncardiac chest pain," I have had responses from 2 physicians who agreed with the thoughts I expressed and 2 physicians who disagreed with them.
The point I tried to make was a simple one. Mainly, the physician who performs coronary arteriography needs to remember that patients and referring doctors are seeking help -- they want a diagnosis. And although I agree that it is useful for the arteriographer to state that the patient has noncardiac chest pain, noncardiac chest pain itself is not a diagnosis. Nor is it satisfactory for the arteriographer to say it is the referring doctor's responsibility to identify the exact cause of the chest pain after he or she indicates that the patient has noncardiac chest pain. Surely arteriographers are sufficiently concerned about solving the patient's problem that they are willing to share their views about the cause of the pain with the referring physician. Surely, arteriographers, who see many patients with chest pain, are interested in the noncardiac causes of chest pain. If they are not, they are giving up their role as doctors and have become technicians, whether or not they recognize their transformation.
There are many causes of "chest pain." Some of them are disabling; many of them are treatable if diagnosed. One of the physicians who reviewed my essay indicated that patients were relieved to know that they had noncardiac chest pain because they were reassured they would not be disabled and that their longevity would not be altered. He forgot to mention that many such patients continue to be miserable, making frequent visits to doctors' offices and emergency rooms, and that some of them are indeed disabled.
Also, the assumption that noncardiac chest pain is not serious is not correct. Even gastroesophageal reflux disease (GERD) may be serious: If persistent and untreated over a long period of time, it may be responsible for Barrett's esophagus.
I must confess, what bothers me the most about the designation of noncardiac chest pain by arteriographers is that it suggests that doctors are not required to make diagnoses and that telling patients what they don't have is considered to be "good enough." Coronary arteriographers have their boards in internal medicine and cardiology. Surely, as cardiologists, they are interested in all of the causes of chest pain that might mistakenly be construed as some form of coronary artery disease. I view with alarm the tendency for a cardiologist to function as a technician. If they choose to function as technicians, one wonders whether, in the future, non-MDs will be trained to do the test.