Wednesday, March 31, 2010

"So you're an EKG technician?"

She says, peering at my work ID as I hand over a few dollars for the bottle of Guinness I've set on the gas station counter.
"Do you just do EKGs, or do you read EKGs?"
"Do you know what PVCs are?"
"Premature ventricular contractions -- or sometimes people say complexes. They're early beats originating from ventricles, the bottom chambers of your heart"
"Are they really bad? I went to the emergency department and they said I had PVCs," says the clerk.
"Usually they're not a very big deal unless you're having a ton of them. It's not uncommon for healthy people to have a few.."
"Hang on a sec.."

She then proceeds to pull out her cell phone and show me a picture that she took of her EKG. I'm amazed that she actually took a picture of a chunk of her EKG. I have no idea how she would have been able to do that.
"Yup. That's a PVC," I confirm.

"They told me that I might have already had a heart attack and that I'll need to have an echo and see a cardiologist."
I look at the EKG again. Only a few leads are visible, but my eyes settle on Q-waves.
"Sometimes people can have 'silent heart attacks' without even knowing it. You'll probably need to have more testing to figure out what's going on."

She toys with her cell phone for a few seconds, and shows it to me again. This time she brings up a video clip of her heart monitor in the ED. It shows ventricular bigeminy.

She tells me that her family has a cardiac history, that she's overweight (obese), that she's only in her thirties, and that she's scared. We talk for a few more minutes, about different kinds of cardiac testing, her cardiologist, and that she's working to change her lifestyle.

This entire situation was bizarre for me. I've never had a stranger stop and question me like this. Is this what happens to doctors?

And what about the whole cell phone thing? I don't know about you, but it makes me sort of uneasy. I am all for keeping patients informed, but it seems like there's a high likelihood of the patient misunderstanding these data. And from a medicolegal standpoint, it seems sketchy.


  1. I've never had a stranger ask me any questions like that, although if I accidentally left my name tag on, it says Forensic Psychiatrist. Not a lot of people are going to open up about THOSE issues to a stranger (although those that do probably need to talking to someone). I do get plenty of (non-psychiatric) medical questions from family and friends though.

    As for the cell phone - if that was done without the hospital knowing, it does seem a bit creepy. I don't think taking pictures or videos of what is going on will lead to misunderstanding things though. In fact, I have heard of an oncologist who audio tapes his visits to give to his patients so that they can listen to the information later when they are in a different state of mind. Obviously you need to be very secure in your opinions to allow patients to walk out with an audiotape of your session. From a medico-legal standpoint, such a move may put you at more risk if you make a blunder, but in my experience, if you know what you are doing and you justify your opinions with solid medical information, you will probably be fine in a court room.

    Having said that, I do think it's a bad thing to record something without getting permission - either for the patient or the physician.

    It's interesting how much this person was reaching out to get medical information. I hope she does see a cardiologist soon to clarify whatever is going on. She's in her 30's and should have a long life ahead of her. Bigeminy with Q waves doesn't sound the best though.

  2. I assumed it was done without the hospital knowing, but maybe someone was okay with it. This happened at the hospital where I work, and I'm not really sure what our policy is. I would imagine the hospital wouldn't want patients photographing their medical records (although a monitor is in plain sight), and we don't have a no-cell phone policy for patients. I have heard of hospitals that don't allow any form of photography, though..

    As for the misinterpretation of data, though, I disagree. I do think it would be very helpful to send patients out with a recording or written record of what's going on with them, in a form that it is easy to understand. However, if my patient requests to view an EKG, I'm more likely to show the person the waveforms without being able to view the interpretation. I would rather explain the EKG to someone then hand them their EKG with terminology that will, most likely, not make sense to the patient. I have met patients who are told that their EKG was benign, but are still freaked out because their interpretation was something along the lines of: "SINUS ARRHYTHMIA. ABNORMAL RHYTHM."

  3. Choosing a technical career in the medical field has proven over the years to provide great job security due to the high demand of qualified medical technicians, along with excellent pay, benefits and an exciting work environment. EKG Technician Salary

  4. Your knowledge and experience in the EKG field helps people feel better when talking to you...or at least more informed. You are in a unique situation to have this knowledge and share it when you can. You could play a key role in getting someone to go in and get a deeper level of analysis done. Even though it's a little strange when patients have too much info, including on their phone, you are providing a great service and helping her out! Thanks for sharing.