8-year-old presents with ADHD presents to cardiology office with ECG in hand for “cardiac clearance” to start stimulants

Case

Hi doctor, this is the check-in desk calling from the waiting room. I have a mother here who has brought her 8-year old son with an electrocardiogram (ECG) in her hands stating that she needs to have this read before she can get a prescription for ADHD medications. You have never seen this child before, but the mother is insisting that the ECG be read today as the child is starting back at school next week. She says her pediatrician won’t allow her to get the prescription unless a cardiologist clears him. I’ve tried to get her to schedule an appointment, but she keeps insisting that all she needs is the ECG to be read by someone to clear her son for stimulant medications. Does this sound like something you can do?

What am I thinking?

To be honest, I am as frustrated as the mother. ECG screening is a controversial topic for a variety of reasons. While seemingly simple, the questions posed raise a number of complex issues. Like many tests, the ECG has strengths and limitations when it comes to providing answers to the type of question posed by this mother. Sometimes it can give a specific answer, but often, it may raise issues well beyond the question for which it was performed. Hence, one needs to be cautious, and not take the matter too lightly. Without understanding the context of the ECG, it can provide false reassurance or send the physician down a deep rabbit hole of tests with no clear end in sight. Therefore, to use an often misused and overused dictum: “Clinical correlation is always advised and necessary.” Which is to say that the context is key. ( Continued at end of chapter ).