Non-cardiac chest pain

doi:10.1136/bmj.324.7342.915

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Patients need diagnoses

David S Coulshed, staff specialist in cardiology.,
Guy D Eslick, gastroenterology fellow. (eslickg@med.usyd.edu.au),
Nicholas J Talley, professor of medicine.

Department of Cardiology, Nepean Hospital, Penrith, New South Wales 2751, Australia
Department of Medicine, University of Sydney, Nepean Hospital, PO Box 63, Penrith
Maryport, Cumbria CA15 8EL

EDITOR—We are concerned about one of the sweeping conclusions in the editorial on non-cardiac chest pain.1 We do not agree that “providing a diagnosis may be less important than addressing a patient's concerns and fears.” Providing a diagnosis is probably the most important part of the care of such patients.

Evidence shows that angiography fails to relieve the anxiety of patients,2 but the psychological and psychiatric complications of chest pain may be at least partially related to general practitioners' inability to provide a definite diagnosis. Continued prescription of antiangina drugs, and possibly failure to investigate further, contribute to continued …