Thursday, July 24, 2008


It has been more than a year since I reviewed the BTS guidelines on management of primary spontaneous pneumothoraces, which I have reviewed again tonight and which had not changed in the interim, so I felt somewhat "rebuked" when I recently aspirated a moderate sized pneumothorax in a patient with COPD and a pleural effusion.

The medical registrar was quite emphatic that that was not the right management. It was.

The matter is noteworthy for two reasons: the first is that I have been trying to review my management of uncommon and rare conditions at the point of care, synchronously, regardless of my confidence in my knowledge or skill simply as good habit; and the second is that personal confidence is only tenuously linked to being right.

I am not confrontational and verbal aggression is only rarely provocative. I am biased by my history to consider only confinement and physical aggression as aggression, so the opinions of colleagues rarely impose. I am free.

I felt vulnerable and I am not sure why.