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Rebuttal From Dr SimpsonRebuttal From Dr Simpson

Tamara Simpson, MD
Author and Funding Information

From the Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center at San Antonio.

CORRESPONDENCE TO: Tamara Simpson, MD, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter Blvd, 111E, San Antonio, TX 78229; e-mail: simpsont2@uthscsa.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1150-1151. doi:10.1378/chest.14-1588
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Extract

Dr Halpern1 has made several very interesting points that warrant further discussion. Physicians indeed have the responsibility to follow screening guidelines, which are established by experts in the field after reviewing all available data, weighing the risks and benefits, and taking into consideration the overall value of a given screening test.2 This patient does seem to be experiencing some psychologic stress related to the residual scar, and this must, of course, be considered when deciding how to proceed. However, the potential downstream psychologic effects and costs and the potential harm to the patient must also be considered. Assuming that this patient does have a scar by radiograph, it is not far-fetched to predict that the CT scan will also be somewhat abnormal, and this could require further potentially harmful imaging and/or procedures in an attempt to offer consolation and closure to the patient. This is a perfect opportunity for the physician to discuss with the patient the natural radiologic evolution of pneumonia, help weigh the risks and benefits of CT imaging, and offer genuine words of reassurance and encouragement for continued smoking cessation.

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