The “Executive Cardiac Health Checkup”

Abstract

PROLOGUE: The “Executive Master Cardiac Health Checkup” (wonder who made that up the first time!) patient makes his entrance into the cardiologist’s outpatient (OP) chamber. It doesn’t require the deductive skills of our friend in Baker street to identify that he has recently returned from either the USA or its neighbor across the Niagara. He looks healthy as a fresh cucumber. And smells even better (Calvin Klein probably). I offer him a smile, a seat, and my hand. He mistakes the intention of my third gesture and hurriedly thrusts a package on to my unsuspecting hand—the colourful and fancy looking Investigation File (gloss finish for the extra effect). “Doctor, all the test reports are here. Blood tests, ECG, Echo are all done. They wouldn’t let me do the TMT without seeing you,” he complained. I thank the technician silently in my mind for having followed my standing instruction faithfully (I have had my share of trouble with unsolicited treadmill tests). I tell him calmly that I wish to talk to him first about his health, then proceed with a clinical examination, and would then give my full attention to the reports in the file. He is clearly not happy. He gives a few not-so-furtive glances at his oversized watch to indicate that he didn’t have much time to waste. POST SCRIPT: After the evaluation, I happily gave the gentleman a “clean chit” and congratulated him on the excellent condition of his heart. He didn’t look as happy as I wanted him to feel though. “Doctor, can I do the TMT now?,” he asked impatiently. One should know when a battle is lost. I smiled, and wrote “Routine check up, No risk factors” against the indication column on the TMT form. The patient proudly came back with the “Negative TMT.” This time, he was smiling from ear to ear, “Thank you Doc, I will be back next year around Christmas for the same check-up.” So much for evidence-based medicine!