I would like to cate~orieally oppost• the use of this procedure by who are not ,·ersed in thoracic sur~t·ry.

pulmonolo~ists

R. William Concin, M.D .. EC.C.P. ( Pulnumary Diseast• and Critical Care .\ledicinc) Prol'idena. Rhode Island

1(, the Editor:

At Mercy llospital and Medical Center here in San Die~o. where am the J\ledieal Direndin~ a l"urse ahout 15 yt•ars a~o. and while it was intri~uin~. I never quite saw a wide enou~h application in my own pral'liet• to persevere. Times have chan~ed, however. and I hdit•ve it is important that the American Colle~e ofClwst Physicians enl,mra~e pulmonolo~ists thron~hont the ~"lmtry to take up this useful procednn·. Further, I helieve it is well within the capability of a l"mpetently trained pulmonary physician to perform. It is another example of proct·dnres that have previously llt'en in the realm of thoracic snr~eons now l~"ming part of pulmonary medicine as well. I ht•lieve that the practicing pulmonary physician has a lot to offt•r patients with nndia~nosed pleural effusions hy nsin~ thoral.,S~"PY· and that our professional or~anizations should support this.

Kt>t>in P. Glyrw. ,\I.D., EC.C.P., Division of Respiratory Carr, Mercy Hospital and Medical Center, San Diego

Tc1 the Editor: I attended a ~'mrse ~iven hy Lon~ Beach Memorial Hospital, which was taught hy Christian Boutin and 'I Aelony, as well as others who have perfi>rmed thousands of thora~"Sl.,pies and are themselves pnlmonologists. There was a thoracic surgeon also speakin~ at the meetin~. and he reiterated his l>t'lief that thoracic snr~eons alone should he allowed to perform this procedure. This was not at all the sentiment of Dr. Boutin or tlw other speakers. I myself work at Mercy Hospital in San Die~o. and we are in the process of trying to establish thora~"'~"PY as a diagnostic tool for the pnlmonolo~ists. As yon might ~uess, there is a ~real deal of resistance on the part of tht• thoracic snr~eons. Their ar~uments art• fi>r the most part spurious and self-st•rvin~. I have attended several thora~"smpies performed by a thoracic sur~eon, and I have found my presence in the operating room invaluable (since this was for the most part a dia~nostie procedure) and have on more than one occasion limited the size and extent of the incision performed. I appreciate the effi>rt that you are makin~ to mobilize the ~"mmnnity of pulmonolo~ists, and I am sure that with time the medical ~"mmnnily as a whole. and patients in particular, will t"me to realizt• that havin~ their dia~nostic workup performed by one person who thinks it through is ultimately in their l>t'st interest.

tube placement to thoracic or ~eneral snr~eons. In the same fashion, it would appear that thoracosmpy is a procedure that could indeed he performed by qualified nonsur~ical physicians. I do think that care would haw to he exercised in the training of such physicians, hut I do not l)('liew· that the procedure by itself necessitates the ability to immediately perform a thoramtomy. At the current time, it is apparent that the American Association for Thoracic Sur~ery and the Society of Thoracic Snr~eons are re