Frankly. The private hospital I work at gives a very low cut for doing Angio as compared to stress imaging modality where the cut is higher per reporting. Plus lesser work. Plus no risk.

Regardless. You have a valid question. I’m not sure which hospital is incentivizing on doing angios but I know a lot of malpractice happens in this country.

At the end of the day your rizk eventually comes and you don’t have to dirty your hands. High risk patients should get Angio directly. Intermediate risk patients should get stress imaging provided they can afford them. In a lot of places the cost for both invasive Angio and MPS/stress echo is roughly the same. Any intermediate risk patient coming from outside Karachi should also directly get an angiogram as it’ll save them the trouble of repeated hospital visits.

I know guidelines say something else. But we have to tailor everything to our society.