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Mary Braun Bates, MD's avatar

Thank you for bringing this to my attention. I am impressed that you highlight the fact that your ideas did not hold up. I am so old that I was taught "Never let the sun set on a pleural effusion" (and, yes, I note that this article only pertains to pleural effusions from heart failure and the training maxim refers to every kind of pleural effusion imaginable). However, when I happen upon a pleural effusion in an elderly patient with heart failure who really doesn't want to go out again to the hospital to get it drained, I will stop feeling that I should try harder to get them to get it drained.

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Free Thought's avatar

As a pulmonologist of over 30 years, I knew this. I am surprised that some may have thought otherwise, but perhaps experienced intuition has some value. The interesting practice that I see repeatedly today, which clearly has no evidence, is that of interventional radiology approaches to pulmonary embolism in hemodynamically stable patients. Similar to thoracentesis for heart failure, many today just can't fathom that removing clot from pulmonary arteries mechanically or with low doses of thrombolytic makes no difference in stable patients. In fact, it may be potentially risky in a relative sense. Perhaps our infatuation with quick results, financial reward for procedures, fascination with new technologies, or just human stubbornness to accept our desires and beliefs over old fashioned evidence is the cause. Interestingly, every study of IR therapy for stable PE patients which demonstrates no benefit ends with the phrase "more studies are needed". The implication is, "well we'll just keep trying until we make the study show what we want it to". Bet on it...

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