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Columnists: Phil Peverley

Heartsink cardiologists

As the aeroplane was leaving the ground to take me and my family off on our holidays, I got a pain in my chest. It was the traditional 'like a knife, doctor' pain, and it was not a pleasant experience. Because I am a doctor I immediately assumed the worst.

I was suffering a spontaneous tension pneumothorax and unless I could fashion an impromptu chest drain from the materials at hand, I was bound for an ignominious, frantic, gasping denouement somewhere over the Atlantic.

I was flying a few days after the latest airport security scare, and our hand luggage was non-existent. Unless we could construct some sort of DIY penetrating device from a copy of the in-flight magazine and a couple of lemon-flavoured wipes, my number was up.

Lady Luck smiled on me that day. My tension pneumothorax resolved after a couple of minutes without the need for homespun cardio-thoracic surgery.

But not all of us get off as easily as I did. Take the lady I saw this morning. She got a pain in her chest just like mine, and her husband took her to A&E. The pain had gone by the time she got there, but the cardiologists were called in anyway, because you can't be too careful. The junior cardiologist examined her, and she seemed to be alright, and the ECG was alright and the chest X-ray was alright and the blood tests were alright, and as a 44-year-old non-smoker she had no risk factors for heart disease, but he admitted her anyway, because you can't be too careful.

She spent two days on the ward. She had an echocardiogram and an exercise ECG, and the results were normal. The pain never came back, and they sent her home with an outpatient appointment for a month later. I got a discharge summary with the diagnosis 'non-cardiac chest pain', and, this is the absolute truth, they gave her a prescription for aspirin, atenolol, simvastatin and a GTN spray.

Now hold on just a cotton-picking minute. Just what is it with these cardiologists? Every single patient of mine who meets a cardiologist in any capacity whatsoever ends up taking a lengthy list of permanent, expensive, often unpleasant and potentially dangerous drugs, and it's just not on. As a professional, you have to have the courage of your convictions. Either you've got heart disease, or you haven't. If the patient has got heart disease, then fine, prescribe. If they haven't, then bloody well don't.

This lady is sitting in front of me. I have a choice; should I collude with this sham? Should I

condemn her to a purgatory of endless medication reviews, questionnaires, EGCs and blood tests? Should I damage her self-image and make her think of herself as ill? Should I make insurance or a new mortgage impossible for her? Or should I rip up the daft prescription?

'Hand it over' I suggest, and soon the air is full of confetti.

Dr Phil Peverley is a GP in Sunderland and PPA Columnist of the Year 2006

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