Correspondence

Mandatory Radiographs after Tube Placement

N Engl J Med 1997; 336:1108-1109April 10, 1997

Article

To the Editor:

Thomas et al. (Oct. 24 issue)1 touch on a controversial issue when they state that “radiographic confirmation of tube placement should be mandatory before material is lavaged through nasogastric tubes.” There are a great many nasogastric and feeding tubes placed, and replaced, in this country. Chest radiography, usually performed at the bedside, is relatively expensive and may not be available in some institutions.

The word “mandatory” should be used reluctantly when applied to the practice of medicine, which remains an art as well as a science. I certainly agree that radiographs should be obtained in most patients before tube lavage, but making them mandatory suggests a “stubborn quest for diagnostic certainty.” 2

Ferris M. Hall, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215

2 References

1. 1

   Thomas B, Cummin D, Falcone RE. Accidental pneumothorax from a nasogastric tube. N Engl J Med 1996;335:1325-1325
   Full Text | Web of Science | Medline

2. 2

   Kassirer JP. Our stubborn quest for diagnostic certainty: a cause of excessive testing. N Engl J Med 1989;320:1489-1491
   Full Text | Web of Science | Medline

Author/Editor Response

Dr. Falcone replies:

To the Editor: Dr. Hall is correct. “Mandatory” should be used reluctantly when applied to the practice of medicine. We stand eloquently and appropriately corrected.

Robert E. Falcone, M.D.
Grant Medical Center, Columbus, OH 43215

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   J. Ness, D. Johnson, N. Nisly. (2003) "Polyherbacy": Herbal Supplements as a Form of Polypharmacy in Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58:5, M478-M478
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