Phillip Zmijewski on the Questions Patients Should Be Asking About Their EKG, and the Ones They Usually Ask Instead

After years of watching cardiac monitors on the telemetry floor, I have noticed a pattern. The questions patients and families ask about their EKG are almost never the ones I would want them to ask. The good news is the better questions are simple. You just have to know they exist. 

The question I get most: “Is my EKG normal?”

It is the natural question. A clinician walks out of the room, the strip prints, and the patient or the spouse standing next to them wants a yes or a no. The answer is rarely that clean. 

An EKG is a snapshot. It captures roughly ten seconds of electrical activity from a heart that beats around one hundred thousand times a day. A normal EKG at 9:14 a.m. on a Tuesday is exactly that, and nothing more. It does not promise the rest of the day will look the same. It also does not mean every prior moment looked that way. 

The better question is, “What is this EKG actually showing right now, and what would change my care if it changed?” That reframes the conversation. It tells the clinician you understand the limit of the test, and it opens the door to a real answer. 

The question they should ask: “What is being monitored, and by whom?”

Most patients do not know the difference between a single twelve-lead EKG done at the bedside and continuous cardiac telemetry. They are not the same test. They are not even the same kind of information. 

A twelve-lead is the photograph. Telemetry is the film reel, running for hours or days, watched by a monitor tech who is often in a different room and sometimes a different building. Asking who is watching the monitor, where they are, and how alarms get to the bedside nurse is one of the most useful questions a family member can ask. The answer tells you a lot about how the unit operates. 

The question almost no one asks: “How many alarms have you silenced in the last hour?”

I do not actually expect a patient to ask this. But I include it because it gets at the real issue, which is alarm fatigue. On a busy floor, monitors generate hundreds of alerts per shift. Most of them are artifact, lead displacement, or a patient brushing their teeth. The clinician’s job is to filter the meaningful ones from the noise. The patient’s job, if they want to advocate well, is to know that filter exists. 

What I would actually ask, if I were the patient, is, “If something on my monitor changed in the last few hours, would I be told, or only if it crossed a threshold?” The answer to that question reveals how the team thinks about you. 

The question that helps the most: “What would make you call a physician?”

This one I love when I hear it. It moves the patient from passive to engaged. It also forces the clinician to articulate the threshold out loud, which is a useful exercise for both sides. 

An answer might be, “A sustained heart rate over one hundred and thirty, or a new rhythm we have not seen on your strip before, or chest pain you describe as different from before.” Now the patient knows what counts. They can flag changes themselves. That partnership produces better outcomes than any single test result. 

The question I wish more families would ask: “What is the trend?”

Cardiac care lives in trends, not single readings. One PVC means almost nothing. Twenty PVCs an hour, with a rising frequency over a shift, means quite a bit. A blood pressure of 138 over 84 is unremarkable. A blood pressure that has drifted from 110 over 70 to 138 over 84 over six hours, in a patient who has not moved, is a story. 

When a family member asks me what the trend looks like, I know they are paying attention to the right thing. The single number is the headline. The trend is the article. 

A small shift, a better outcome

None of these questions require a medical background. They require a small shift in how you think about what monitoring actually is. It is not a verdict. It is a continuous conversation between the patient, the equipment, and the people watching it. 

The patients and families I remember most are the ones who learned to ask about the conversation, not just the verdict. They got better information. They got better care. And in a few cases I can think of, they probably got better outcomes because of it.

Also Read: The Pro Guide to Digital Billboard Advertising Strategy