Do You Need An EKG?

Would it surprise you to know that sometimes I refuse to do what my doctor wants?  It shouldn’t – doctors are people too, and we have opinions that may differ from each other.

At my annual physical yesterday, the medical assistant explained that my doctor likes to do EKGs on all her adult patients when they have physicals.  I declined and I’ll tell you why.  Do you need an EKG?

Currently it is NOT recommended by the United States Preventive Services Task Force OR the American Academy of Family Practice to do routine EKGs.  That means that unless you have symptoms of heart problems (chest pain, dizziness, fainting, heart palpitations, etc) or risk factors for heart problems (high blood pressure, high cholesterol, diabetes or a strong family history of heart disease) you do NOT need an EKG.

Some people would say, “Dr. Jen, what’s the harm in getting an EKG?  It doesn’t hurt, it’s not invasive, it’s simple and inexpensive and can be done right in my doctor’s office.”  While that’s correct, you have to remember that no test is perfect.  Even a simple test like an EKG can have what’s called a false-positive result.  That means the test result is abnormal, even though nothing is wrong.

If a person is very unlikely to have the problem that we’re looking for, then positive results are more likely to be false-positive than truly abnormal.  And remember, the next test done for a patient with an abnormal EKG (to find out whether it’s a false positive or not) is a stress test.  That’s a much more expensive test that still has a risk of false-positive results.  Remember what I said before, no test is perfect!

If your doctor wants to do tests, it is important that you understand why they are recommended, what problems the doctor is looking for, and what the next test would be if the test is abnormal.

Want to see what the current recommendations are?  There are two commonly used places to look.  The United States Preventive Services Task Force is a government agency that examines the research and makes recommendations about what preventive services people should have at different ages and stages of life.  This agency is important because in some respects their recommendations are used to determine whether testing is covered by Medicare, Medicaid and commercial insurance companies.  You can click the USPSTF link above to check current recommendations.

My professional organization is the American Academy of Family Practice.  For the most part, the AAFP follows the USPSTF, but not always.  Sometimes the AAFP doesn’t agree.  You can see the American Academy of Family Practice’s recommendations at the link above.

Every doctor is responsible for keeping up on the current recommendations.  In fact, a lot of our continuing medical education is focused on the changing world of screening tests.  As more and more research is done and published, testing recommendations will continue to change.

It is confusing for patients when screening recommendations change, but that’s what doctors are for!  Doctors have to explain these changes and the reasons for them to patients so they understand.  We want to do the right tests for each patient to keep them healthy. We have to look for problems that need to be diagnosed and treated early.  Doctors should also avoid spending health care dollars on tests that don’t contribute to meeting these goals.

QUESTION: Does your doctor do routine EKGs for you when you have your physical?  Will you talk to him or her about this topic when you go in next time?

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