Author response: Clinical Reasoning: A 56-year-old woman with acute vertigo and diplopia

In Opinion and Special Articles: Stress when performing the first lumbar puncture may compromise patient safety, Henriksen et al. evaluated the stress of 46 physicians performing a lumbar puncture (LP) and found that novice physicians are more stressed than intermediate or expert physicians when performing LPs. In response, Dr. Sethi noted that novice physician stress when performing a LP may be due to the fact that (1) novice physicians may be overworked or sleep-deprived and (2) novice physicians may be more likely to perform LPs in suboptimal conditions, such as in a time crunch or in the emergency department. Author Henriksen agrees with Sethi that extrinsic factors can affect physician stress when performing an LP, but notes that the conditions for LP performance were identical for all 46 physicians in their study. Training may help to decrease novice physician stress when performing LPs.