echocardiogram – The Health Care Blog

Adventures in how screwed up health care is, number 436

Aug 26, 2025

By MATTHEW HOLT

(I copied this here from Linked in where it 65+ comments just so I can find it when the story continues) Too painful to write up fully but I am on my 4th transfer in one phone call to MarinHealth trying to get an echocardiogram (EDIT-not an EKG as I originally wrote). They have lost the referral from One Medical twice. I had to download the referral and email it to them (Lucky it’s on the One Medical system). Every person has asked for my DOB and phone number. The guy who got the email, read the referral and transferred me. The latest guy appears very puzzled & wants me to fax him the referral. Eventually he gets me to his supervisor who says that radiology & cardiology are separate and they can’t receive an email because it’s a HIPAA violation. (I claimed to be Lucia Savage & laughed at him). Now I have to figure out how to fax it to them and the supervisor promised to call me back. He had to ask for my phone number….

Oh and I can’t book a echocardiogram on MyChart, but I can book a mammogram.

I’ll follow up in the comments. BTW that phone call was 19 minutes

UPDATE: OK, so I faxed them via a dodgy efax company whose “free trial” I need to remember to cancel. The supervisor did call me back, but for some reason my phone didn’t ring! He left a message and booked an appointment for me. But not in their Marin facility. In the next county over! (And Sonoma is very lovely). A 45 min drive rather than a 10 min drive from my house. I can SEE the appointment in the UCSF MyChart, and I can cancel it. but I cannot request a change or see when I could book one closer to me (presumably at a later date). So I guess I will call back on Monday….

UPDATE: So I called back today and got the appointment changed to the closer location. I had to wait one more day… I know you are all on tenterhooks so I will tell you if my heart works in 2 weeks!

UPDATE to the Update. A human called me and cancelled my appointment. Apparently the tech was out sick. Still no word on whether I have a heart or just a black pit inside my chest

UPDATE: I finally got in and had the Echocardiogram. Marin Health had an iPad based fast check in (well done). I didn’t recognize whose software it was. The echocardiogram took 45 minutes and was a bit like having somone stick their finger in your chest the whole time. Yes I do have a heart! More to come

A Tale of Two Doctors

Nov 3, 2017• 10

By ROBERT MCNUTT, MD

Data is not always the path to identifying good medicine. Quality and cost measures should not be perceived as “scores,” because the health care process is neither simplistic nor deterministic; it involves as much art and perception as science—and never is this more the case than in the first step of that process, making a diagnosis.

I share the following story to illustrate this lesson: we should stop behaving as if good quality can be delineated by data alone. Instead, we should be using that data to ask questions. We need to know more about exactly what we are measuring, how we can capture both the physician and patient inputs to care decisions, and how and why there are variations among different physicians.

A Tale of Two Doctors

“As soon as I start swimming, my chest feels heavy and I have trouble breathing. It is a dull pain. It is scary. I swim about a lap of the pool, and, thankfully, the pain goes away. This is happening every time I go to work out in the pool”.

Her primary physician listened intently. With more than 40 years of experience, the physician, a stalwart in the medical community, loved by all, who scored high on the “physician compare” web site listing, stopped the interview after the description and announced, with concern, that she needed to have a cardiac stress test. The stress test would require walking on a “treadmill” to monitor her heart and would include, additionally, an echocardiogram test to see if her heart was being compromised from a lack of blood flow.

“But, I have had three echocardiogram tests in the last year as part of my treatment for breast cancer and each was normal. Why would I need another”?

“Well, I understand your concern about more tests, but the echocardiograms were done without having your heart stressed by exercise. The echo tests may be normal under those circumstances, but be abnormal when you are on the treadmill. You still need the test, unfortunately. I want to order the test today and you should get it done in the next week”.

The Unheard Heart: A Metaphor For Medicine In the Digital Age

Nov 2, 2012• 10

By Clifton Meador, MD

A few months ago, a young cardiologist told me that he rarely listens to hearts anymore. In a strange way, I was not surprised.

He went on to tell me that he gets all the information he needs from echocardiograms, EKGs, MRIs, and catherizations. In the ICU, he can even measure cardiac output within seconds. He told me that these devices tell him vastly more than listening to out-of-date sounds via a long rubber tube attached to his ear.

There was even an element of disdain. He said, “There is absolutely nothing that listening to hearts can tell me that I don’t already know from technology. I have no need to listen. So I don’t do it much anymore.”

I began to wonder. I called my longtime friend and colleague, also a cardiologist. I knew him to be one of the best heart listeners. I asked him if he still listens to hearts. He answered, “Of course I do. I could not practice medicine if I didn’t. But you know every week, several patients tell me when I listen to their hearts that I am the first doctor ever to do that. Can you imagine that?”

Playing the devil’s advocate, I challenged my friend to tell me what he learned from listening to hearts.

He answered, “How could anyone not want to hear those murmurs, sometimes ever so soft, like whispers? Murmurs from the heart, even very faint ones, are trying to tell us significant things. Some sounds are very localized, even hidden or obscured by layers of air. And then there is the rhythm and the beat and the cadence that you cannot hear on the paper strip of the EKG. Also, careful listening is the only way to appreciate the rubs of friction if there are any. The devices are important, but the heart has its own spoken and unspoken language if you know how to listen.