Who keeps ordering all these ECGs? 

I don’t know maybe I am getting old and the world is spinning too fast for me to keep up with. Maybe I missed a Lancet article maybe there is an ACEP guidance that failed to catch my attention, but somehow I have been getting the feeling that we are making way too many ECGs. 

When I grew up we were doing medicine based on a good history and a decent physical and we ordered tests only when every other option to us was exhausted. This (thank you for putting that out to me dear reader) included doing unnecessary surgery on patients with abdominal pain giving lasix to COPD patients and relying on meningismus to diagnose meningitis. But still, at least we put some effort into reducing testing. These days that incentive has long disappeared from the face of the (ED) world. I must admit I have grown to like the CT scan here and there, the point of care ultrasound for whatever occasion or even an ED TEE if you can… well because you can. What I have trouble accepting is this:

“Why on earth does every patient in the world always every time get an ECG and who orders these bloody things?” 

I am not talking about syncope or chest pain, not about shortness of breath or even suicide attempts. I am talking about patients with established covid infections, appendicitis and bloody ankle sprains. Everybody seems to be eligible for a twelve lead. Now don’t get me wrong I don’t mind the nurses putting on the rubbery sucky things on the patient’s skin – And I don’t mind the enormous paper waste (where do they get all that pink paper from anyway), It is a non-altruistic need for self-preservation: I need my life back. Because even though looking at an ECG may only cost me a few seconds, more and more I am feeling that my purpose in life has shifted from the relief of suffering to reading ECGs that I never ordered. 

So, wanting to stay away from the debate about who needs and who doesn’t need…. I want to propose the following thing.

ECGs for indications other than chest pain or syncope, or on the specific request of me can only be made if any of the following statements apply.

• The ECG was made by a nurse that was on her break
• The ECG was ordered by a junior doctor that first got me coffee (espresso, one sugar)
• The patient him or herself is either a cardiologist or a lawyer
• The doctor taking care of the patient is an orthopedic surgeon (because, well its funny to see them struggle)