Relative riskBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39129.623368.BE (Published 27 September 2007) Cite this as: BMJ 2007;335:666
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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.
Mounir(Munir) E Nassar, M.D.,FACP
Competing interests: No competing interests