Letters

Author's reply

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7005.627c (Published 02 September 1995) Cite this as: BMJ 1995;311:627
  1. John F Goodwin
  1. Emeritus professor of clinical cardiology Royal Postgraduate Medical School, London W12 0NN

    EDITOR,--Tom Woodcock and Adrian P H Steele both concentrate on the issue of pulmonary artery catheterisation in critically ill patients, but my main message was the importance of using high technology investigations to complement rather than replace clinical skills in patients who are not acutely ill. I am aware that clinical signs can be unhelpful in desperately ill patients with severe circulatory problems, but that does not mean that clinical signs can be ignored. I agree with both Woodcock and Steele that assessment by Swan-Ganz catheterisation is crucially important in acute intensive care. This makes it all the more vital that all who use the technique fully understand its value and limitations and do not ignore clinical features entirely.

    I thank Woodcock for pointing out that the page numbers of two of my references were wrong, and I apologise for this. I do not know what he means by his comment about a story in a “Sunday newspaper.” Perhaps he is referring to the passage that I quoted from the Observer, which is the house journal of the American College of Physicians.

    The tone of Woodcock's letter suggests a deep sense of personal outrage, which I much regret. I had no intention of insulting anyone: my purpose was to emphasise an important principle in the care of patients.

    Finally, I welcome Chris Butler's point about using clinical skills to avoid the inappropriate use of expensive resources. Also, as I pointed out, failure to conduct a proper clinical assessment can lead to inappropriate investigations that can miss the diagnosis completely.

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