Can Patients Read Their Own ECG?
No, patients should not independently interpret their own ECGs—accurate ECG interpretation requires extensive medical training, supervised experience reading hundreds to thousands of tracings, and integration with clinical context that only qualified physicians can provide.
Why Patients Cannot Reliably Interpret ECGs
Training Requirements for Competent Interpretation
Physicians require interpretation and review of 800 ECGs within a 3-year training period under experienced faculty supervision to achieve basic competence, reflecting a wide variety of clinical situations and ECG abnormalities 1
Cardiology fellows are recommended to read 3,500 ECGs during their training to develop expertise 1
Even after completing residency training, board certification, and Advanced Cardiac Life Support training, physicians require ongoing practice and continuing medical education to maintain competency 1
First-year internal medicine residents—who have completed medical school—demonstrate low overall proficiency in ECG interpretation at the start of their training, correctly identifying only half of critical diagnoses 2
The Complexity of Accurate Interpretation
ECG interpretation is a complex cognitive skill that requires systematic analysis of multiple technical parameters including heart rate, rhythm, intervals (PR, QRS, QT), axis determination, chamber enlargement, and identification of ischemia, injury, or infarction patterns 3, 4
The same ECG pattern may occur in different pathophysiologic states, requiring a skilled physician to integrate clinical data and provide differential diagnosis 3
Interpretation accuracy varies greatly even among expert electrocardiographers, underscoring the difficulty of this skill 4
Critical Need for Clinical Context
The ECG must never be interpreted in isolation—it requires integration with the patient's clinical presentation, symptoms, and medical history for accurate diagnosis 3, 4
Noncardiologists are more influenced by patient history when interpreting ECGs than cardiologists, but this clinical context is essential for proper interpretation 1, 3, 4
Clinical signs and symptoms alone lack sufficient sensitivity (35-38%) and specificity (28-91%) to rule in or rule out acute coronary syndrome without ECG interpretation by qualified physicians 3
Even Computer Interpretations Require Physician Verification
Computer-generated ECG interpretations are helpful adjuncts but are not substitutes for physician interpretation—they must always be verified by a qualified physician 3, 4, 5
Computer algorithms make critical errors in detecting arrhythmias, pacemakers, and myocardial infarctions in many abnormal ECGs 5, 6
In one study, 19% of ECGs were incorrectly interpreted as atrial fibrillation by computer algorithms, requiring physician correction 7
Inexperienced physicians may fail to recognize computer interpretation mistakes and accept automated diagnoses without criticism, leading to clinical mismanagement and potentially dangerous treatment 6
Important Caveats
Misinterpretation of ECGs can lead to inappropriate diagnoses, unnecessary investigations, delayed treatment of life-threatening conditions, or exposure to potentially dangerous therapies 6, 2
Technical factors such as electrode misplacement, inadequate filtering, or artifacts can significantly alter ECG findings and lead to false diagnoses—issues that untrained individuals cannot identify 3, 4
Critical findings like ST-segment elevation myocardial infarction require emergent reperfusion therapy, and delays from misinterpretation directly impact morbidity and mortality 3
The Bottom Line
Patients lack the extensive training (hundreds to thousands of supervised ECG interpretations), systematic analytical framework, clinical integration skills, and ability to recognize technical artifacts that are essential for accurate ECG interpretation. Even computer algorithms—which are far more sophisticated than untrained interpretation—require mandatory physician verification due to frequent critical errors. Patients should always have their ECGs interpreted by qualified physicians with appropriate training and ongoing competency maintenance 1, 3.