We are often seeing patients with an order for a stress echo that have never had an echo. During the course of the stress echo, it often becomes apparent that a complete echo needs to be done. Can the cardiologist, not unlike a radiologist, make the decision to also do a complete echo at this time? Of course, the reason would be documented. The other option is to contact the ordering physician which may or may not happen during the same encounter which would cause the patient quite an inconvenience.