Non-cardiac chest pain

doi:10.1136/bmj.324.7342.915

BMJ 2002;324:915 ( 13 April )

Letters

Non-cardiac chest pain

Patients need diagnoses

Rapid access clinics lead to deskilling of general practitioners

Patients need diagnoses

The first 150 words of the full text of this article appear below.

EDITOR $---$ We are concerned about one of the sweeping conclusions in the editorial on non-cardiac chest pain.¹ We do not agreethat "providing a diagnosis may be less important than addressinga patient's concerns and fears." Providing a diagnosis is probablythe most important part of the care of suchpatients.

Evidence shows that angiography fails to relieve the anxiety of patients,² but the psychological and psychiatric complicationsof chest pain may be at least partially related to general practitioners'inability to provide a definite diagnosis. Continued prescriptionof antiangina drugs, and possibly failure to investigate further,contribute to continued anxiety. Patients with chest pain of non-cardiacorigin need a label to hang onto.

Because there is often more than one diagnosis, we suggest using the label "chest pain of unexplained origin." A multidisciplinaryapproach could be useful, with particular attention being paidto psychological factors.³ Nijher et . . . [Full text of this article]

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Chest pain in people with normal coronary anatomy: Gurjinder Nijher, John Weinman, Christopher Bass, and John Chambers
BMJ 2001 323: 1319-1320. [Extract] [Full Text] [PDF]

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