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July 25, 1986

Two Consultations: Cognitive Services vs Procedures

Author Affiliations

Trenton, NJ

JAMA. 1986;256(4):472-473. doi:10.1001/jama.1986.03380040046022

To the Editor.—  While I am sympathetic to the plight of Dr Cowan1 and the time he spent treating a sick patient with prostatic carcinoma, I do not understand the events surrounding the placement of the pulmonary artery catheter in the second patient.Since he describes the entire procedure as taking only five minutes, he must have performed this dangerous, invasive procedure without a thorough chart review and examination of the patient. Several questions arise:

  1. Did the patient really need a pulmonary artery catheter?

  1. Who obtained informed consent?

  2. Was there a concomitant coagulopathy or dysrhythmia that would have precluded the procedure?

  3. Did anyone check the postinsertion chest x-ray film for position of the catheter?

  4. If not Dr Cowan, who managed the patient after the catheter was placed? Was it the primary physician, who obviously did not know how to insert the device? I wonder