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Sestamibi Imaging to Triage Patients With Acute Chest Pain
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To the Editor: Dr Udelson and colleagues1 reported that 42% of patients ultimately found to be without acute ischemia were still admitted to the hospital despite a negative sestamibi scan result. They concluded that further improvement in ED triage decision making is possible, indeed necessary. I believe that this decision by treating physicians was motivated by the fear of being sued for failure to diagnose a myocardial infarction. For instance, 1 study has found that of 349 closed cases of malpractice between 1985 and 1995, there were 195 that included errors in diagnosis and another 109 involving both diagnosis and treatment errors.2 Diagnostic errors are still the most prevalent medical mistake related to myocardial infarction.3
Basically, the standard of care has become perfection, and no patient will be discharged if there is any possibility whatsoever of underlying myocardial ischemia. In my experience it is not unusual for the ED physician . . . [Full Text of this Article]
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