Can the importance of a test be judged by the volume of tests ordered? Fisch1 estimated in 1989 that approximately 100 million electrocardiograms (ECGs) are recorded annually at an approximate cost of $5 billion. That many of the 100 million ECGs were unnecessary cannot be questioned. It is useful, therefore, that we constantly review the need for all routine testing with a view to balancing cost against patient benefit. Also in 1989, it was estimated that 10 million outpatient surgical procedures were performed.2 Preoperative ECGs were likely to have been obtained for most of the surgical patients over the age of 40 years, as has been recommended by Goldberger and O'Konski.3 In this issue, Gold et as4 question the need for routine preoperative ECGs for ambulatory surgery in patients under the age of 60 years. The authors base their conclusion on the results of a retrospective
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