101 reasons not to do an ECG....

Although this patient's diagnosis was Cardiogenic shock & this was their ECG when they presented with chest pain & shortness of breath the patient continued to receive treatment for infective exacerbation of Asthma only, revealing the real reason why ECGs are rarely done.......

When I was a doctor (in the UK!) working in emergency medicine, I used to keep a mental note of all the reasons people presenting with a 'Boxer's fracture' (the clue is in the title) - strangely getting drunk, angry & punching someone was rarely the history offered.

Now that I am not a doctor, volunteering in Cambodia, I have another favourite pass-time, what is the reason for not doing an ECG?

So far on ICU medicine I have these reasons/excuses;

1) The patient was too sick

2) The patient was a 'hopeless case' so they didn't bother to do anything

3) The patient was too sweaty - they use suction for the leads & not stickers so this one is really quite ridiculous

4) The patient was too agitated - this is commonly used for patients that when I go to assess are either unconscious or sitting calmly

5) An ECG is not indicated - these are commonly patients with a) Tachy/brady cardia b) Chest pain c) Breathlessness d) Loss of consciousness

6) The patient had a nose bleed - my favourite excuse!

7) Nurses who can not do an ECG - instructions are on the machine/I have shown them how

8) Doctor can not do the ECG- instructions are on the machine/I have shown them how AND they are taught how to do them at medical school but forget because they never do them in practice

9) The ECG machine has no paper

10) The ECG machine has no ink

11) There was no electricity to do it/battery was flat - oddly the AC in the directors office always works even when there is a power cut

12) The staff were "too busy" to do one

13) I think my VA may have stubbled across the real reason ECGs are rarely done & if performed NEVER acted upon, Dr V took her to one side last week & explained to her "I don't know how to read an ECG"

“Growth begins when we begin to accept our weaknesses.” ~Jean Vanier