EDITOR,--C M Francis and colleague's report on open access echocardiography1 highlights the fears of many cardiologists about open access services.2 The principal aim of the author's service—the identification of patients with left ventricular dysfunction so that treatment with an angiotensin converting enzyme inhibitor could be started—occurred in only 50 (19%) of 259 patients, while valve disease was identified in 12. In a similar study of an open access exercise electrocardiography service McClements et al identified ischaemic heart disease in only 18% of the 192 patients tested.3 It is argued that a negative result of the test is reassuring, but many patients remain symptomatic despite reassurance.4 Furthermore, screening a low risk population …