Innocent murmurs: Echocardiography and the diagnosis of cardiac normality

Abstract

Abstract Echocardiography (cardiac ultrasound) is a spectacular imaging test. This paper presents results of a two year study of 40 patients referred for the test to ‘reassure’ them that their hearts are normal. Analysis is based on recordings of consultations in private and public practice and interviews with patients and cardiologists. The test is shown to have little technical impact on the diagnosis. The cardiologists diagnose most patients as certainly or most probably normal on clinical examination. This clinical evidence may over‐rule the test result. The major purpose of the test is to mediate social relations with colleagues (to satisfy referring physicians and to justify reversal of their diagnoses) and to reinforce social control over patients. While most patients feel relieved by the test result, many are left worse off as a result of the test. Thus, even when a test is used to diagnose a murmur as ‘innocent’, the process of diagnosis may be harmful to patients.

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