Any scientific paper recommending enhanced screening or treatment that does not take into consideration the value of the proposed recommendation is severely limited. I use “value” in the context of medical ethics, specifically, its impact on beneficence (acting in the best interests of the patient), non-malfeasance (do no harm), and justice (fairness and equality related to the distribution of scarce resources). This requires health-care providers to become more familiar with the meaning of quality-adjusted life year (QALY) and how it is derived so that we can holistically assess the value behind a proposed recommendation.

This month’s issue of Grand Rounds reports on a study in which college athletes were screened with routine history, physical examination, and 12-lead electrocardiography prior to athletic participation.1 What percentage of physicians or family members would agree that detecting five additional athletes with cardiac abnormalities out of 510 would be “worth it”? However, 16.9% of the athletes were incorrectly informed they had a cardiac abnormality. Is this in the best interest of all athletes? Without measuring the negative impacts of what a “false positive” means to a patient and his/her family, how can we holistically understand our patients and what they value? The concept of justice, and how health care dollars should be spent to promote the greatest good for the greatest number of people, a societal good, should never be a consideration when assessing a singular patient in front of us. Regardless of the philosophical considerations of what value means to patients, I believe it is imperative that physicians understand such terms such as QALYs, Utility Values, and Quality of Life Instruments; otherwise, we may fail to holistically understand our patients’ values and not be able to advocate on behalf of their needs, while deferring these decisions to bureaucrats who may be proficient with economic data but deficient in promoting patient-physician relationships.

The burden of cardiac nondisease associated with detection of functional murmurs was well described over 40 years ago.2 Proponents of ECG screening might reflect on Santayana’s observation: “Those who cannot learn from history are doomed to repeat it.”

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