KevinMD January 24, 2026
A patient with diabetes, hypertension, and obesity comes in for her annual wellness visit. The physician has already spent 20 minutes on chronic disease management and lifestyle guidance. As the visit wraps up, the patient mentions daily heart palpitations that started a month ago.
The exam was benign. The physician has two choices: spend another 20 minutes performing an EKG, discussing differential diagnoses, and developing a workup plan; or refer to cardiology.
The physician refers to cardiology.
Six months later, the patient returns. The cardiologist ordered extensive testing, all negative, started a beta blocker, and scheduled follow-up. The palpitations persist. The patient is frustrated by the cost, the wait, and new medication-related fatigue.
The physician realizes what could have been...
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