Can clinical assessment of chest pain be made more therapeutic?

We describe the referral and management of consecutive patients attending a cardiac service with the presenting complaint of chest pain. Of 610 consec utive new referrals to five Oxford cardiac clinics over 12 weeks, 202 had c hest pain as the presenting complaint: 91 (45%) angina, 101 (50%) non-cardi ac chest pain, 8 (4%) both and 2 (1%) uncertain diagnosis. Information in c linic letters was sometimes ambiguous and contradictory and suggested a lac k of precise information to patients. Patients with non-cardiac chest pain often had long histories, including considerable previous use of services a nd specialist investigations. There were delays in referral and assessment of patients. There are opportunities for simple changes in assessment proce dures which might have substantial advantages for outcome and resource: (i) more detailed referral information from general practitioners, with an exp licit statement of the reasons for referral; (ii) minor modifications to au gment the assessment by provision of unambiguous information to patients an d primary care at discharge.