Why did you order that echo?

It was a case of CYA. It's a compelling anecdote about an academic cardiologist who, after a thoughtful and thorough clinical evaluation, orders an unnecessary echo “just in case.”

The last thing I did was order an echocardiogram—then came the fellow's question.

The answer was simple but painful: I was practicing defensive medicine. “If she has a familial hypertrophic cardiomyopathy or arrhythmogenic right ventricular dysplasia and I don't diagnose it, what do you think would happen to me?” I was embarrassed to admit it, but I had fallen prey to the most miserable excuse for test-ordering. The fellow was kind (or smart) enough not to point out there was nothing to suggest either diagnosis, the pretest probability was abysmally low, and the test would cost the healthcare system at least $500.

The author points out the tremendous waste in this approach. But in today's practice environment he'd do it again, and so would you. This is a compelling case for tort reform, something we didn't get in the recently passed health care reform legislation.