There is a big move in cardiology (and with everything else) to move more care out into the community.  Many diagnostic tests however are still performed in secondary care settings. Many cardiology departments offer direct access to a number of cardiology tests where the test (but not the patient ) will be reviewed by clinician in hospital with some management advice back to the primary health care provider. I think this kind of system can work very well but I was reminded of the flip side by a telephone conversation I had this morning. The patient under discussion is difficult to assess from the point of view of history, has a normal bedside examination and a normal 12 lead ecg other than sinus tachycardia.  After discussion we agreed further tests   - an echocardiogram and a holter  if thyroid function and full blood count are normal. I'm wondering now however whether if I had seen the patient I might have done less?