The ECG Made EasyBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3070 (Published 29 July 2009) Cite this as: BMJ 2009;339:b3070
- David Warriner, core medical trainee year 1 (diabetes), Northern General Hospital, Sheffield
A true medical classic should be novel, stimulate thought and discussion, transcend both specialty and experience, and most importantly be moreish. This pocket sized hero, the epitome of the medical classic, explains the “three Rs” of the electrocardiogram—rate, rhythm, and right (or left) cardiac axis—in plain English and with elegant diagrams. Hampton encourages the reader to consider this most complex of patterns as “amenable to reason.” After first reading it in my fourth year at medical school during my cardiology attachment, I began to make sense of this bewildering cacophony of oscillations and amplitudes.
Apart from bedside observations such as blood pressure and temperature, the electrocardiogram (ECG) is the most commonly used non-invasive tool of investigation. The indications are manifold: chest pain, shortness of breath, collapse, loss of consciousness, before and after operations, on treadmills. Thus the taking and interpreting of the ECG is one of many essential skills needed not only for medical students to pass finals but to become a competent doctor.
Only by understanding the science of the heart can you make sense of the ECG. Indeed, this is one of the founding tenets of medicine: understand the anatomy and physiology, know the pathology. Yet how often do we allow our students time to understand first principles, as the undergraduate curriculum becomes increasingly crowded, forcing them to rely solely on rote and pattern recognition?
The author describes a further tenet: “It is the patient that should be treated, not the ECG.” It is a lesson many of us would do well to heed. Indeed, here you could substitute any test for the ECG, as in this increasingly defensive and test heavy world we are forgetting to do the basics well, trusting seemingly infallible tests and distrusting our own eyes and judgment.
My favourite part of the book is the pictorial representations of the heart and its conducting pathway, which, like the ECG, convey what it would take many words to describe. I also enjoyed Hampton’s perhaps inadvertent use of black humour when describing ventricular fibrillation: “As the patient may have lost consciousness by the time you realise the rhythm is not due to a misplaced lead, the diagnosis is easy.” Indeed.
He also says that “there is no substitute for the reporting of large numbers of clinical records for the development of clinical competence and confidence.” Passing finals is merely a licence to drive, but becoming a competent driver comes from spending many hours behind the wheel—the ECG machine or whichever skill one wishes to master.
Cite this as: BMJ 2009;339:b3070
The ECG Made Easy
John R Hampton
First published 1973