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FILLERS: Stephen J Hanna Relative risk BMJ 2007; 335: 666 [Full text]

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An ethical problem

Mounir (Munir) E Nassar, M.D., FACP   (7 October 2007)

An ethical problem 7 October 2007
Mounir (Munir) E Nassar, M.D., FACP, Retired. No affiliation with medical school Pittsford, NY 14534 USA Send response to journal: Re: An ethical problem	In responding to "When is hospital the right place to be" by Dr. Hanna, BMJ 2007 335:666 (September 29), it is my opinion, that the bottom line is an ethical problem. In a free society, the patient provided he or she is competent, has the final choice of where his chest pain complaint is to be evaluated. It is his prerogative. I am not certain that it solves the problem (though it may help) educating the public about the importance of symptoms of chest pain, and the course of action to take : Chew a tablet of aspirin, stop all activity and rest, take sublingual nitrite if available (ideally baring complications) times three 5-7 minutes apart if symptoms persist, and call ambulance for transport to hospital for immediate evaluation, but in the final analysis it is the patient's decision whether to go or not. In the instance of the general practitioner, the patient refused to go to a center for chest pain evaluation, the practitioner should have a short conference with patient and immediate next of kin explaining the dire consequences, including demise, and with documentation. On a final note chest pain maybe expeditiously evaluated using the underutilized timed 2-d echocardiogram in the emergency department. Sincerely, Mounir(Munir) E Nassar, M.D.,FACP Competing interests: None declared