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Has Technology Failed Us? Doctors Match Machines in Spotting Heart Disease

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There are many aspects of what is sometimes called the “gold standard” of medicine that have been scrutinized by science and found to be lacking. Episiotomy—the surgical incision of the perineum during childbirth to facilitate delivery—is one; the routine use of blood transfusions is another. Now another gold standard is coming under a cloud of doubt: the use of EKG to predict future heart problems for people who have chest pain.

The November 13 online issue of BMJ followed over 8,000 patients with no history of heart disease who were referred to chest pain clinics because of suspected heart related chest pain. The researchers concluded that 47% of the coronary events (heart attacks and the like) occurred to those people whose exercise EKGs did not indicate any heart problems. They went on to state that while EKGs do help determine whether chest pain is caused by a heart problem, the EKG was no better at predicting heart disease than was the physician doing his or her own examination of the patient.

To try to separate real gold standards from false, there are sources like the Dartmouth University Foundation for Informed Medical Decision Making. This is a non-profit organization dedicated to ensuring that people understand their choices and have the information they need to make sound decisions affecting their health and well-being. They do so by promoting understanding and adoption of informed medical decision making; organizing and framing medical evidence in an unbiased manner to help people evaluate their options, particularly in instances where differences in individual preferences and perspectives are likely to affect personal choice; and sponsoring research to expand knowledge of how to improve decision quality in healthcare.

According to research from Penn State University, over 90% of what is practiced in allopathic medicine is defensive medicine—that is, treatment that is not necessary except for medico-legal purposes and medical regulatory reasons. And defensive medicine has consequences. Dartmouth University professor Gilbert Welch, M.D., explains the downside of over-diagnosis in his book Should I Be Tested for Cancer? Maybe Not and Here’s Why.

Leading integrative physicians (such as Sidney Baker, M.D., speaking at a recent Institute of Functional Medicine symposium) point out the wisdom of “listening to your patient” And using clinical experience not just machines to diagnose.

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