Since becoming a father I’ve had intermittent chest pain. Not sure why, but it’s worse when I lie on my left side and sometimes hurts with deep breaths. All gone when I go running however. I’m not worried (and neither should you be mom), but it got me typing.
I’ve had a few calls now from people having chest pain also. I usually lead with some version of “I’m sorry, but I have to say this… If you’re having chest pain, I’d be crazy to not point you toward an ER or 911 (…pause…) but if you’d like to have more of a conversation about how we think about chest pain, then I’m happy to have a chat.”
Unfortunately chest pain can be anything from a bent-up burp to a rupturing aorta. Probably every doctor has been surprised by findings (or lack thereof) on EKGs, chest X-rays, CTs, and blood tests. Heartburn? – nope – heart attack. Pregnancy dyspnea? – nope – pulmonary embolus. Sore ribs from a hard football hit? – nope – pneumothorax.
Red flags and happy words are useful when thinking about chest pain, as they are for any other problem. But patients really should have access to these, because they, possibly more than even their doctors, should be their own best advocates here. I’ve referred to the “principal agent problem” a few times in the past, and in this case the agent (doctors) have very strong forces pushing the principal (patients) toward every study under the sun. When doctors make mistakes with chest pain it’s more than life and death. It’s life, death, guilt, shame, paper work, lawsuits, etc.