Editors' note: Opinion and Special Articles: Stress when performing the first lumbar puncture may compromise patient safety

I read with interest the Henriksen et al.(1) article on physician stress levels while performing lumbar puncture (LP). They concluded that stress levels of physicians who are LP procedure novices was high before and during procedure performance as compared to physicians who are experts in this procedure. The high stress levels in LP procedure novice physicians was directly related to patient confidence in the operator and risk of post LP headache. This study fails to take into consideration many physician extrinsic factors that determine the outcome of LP. LP procedure novice physicians are most likely to be physicians in training who, many times, are performing the procedure in less than optimal conditions, such as late at night under emergent situations when time is limited, operators are overworked and sleep-deprived, and the patient is frequently in an altered mental state lying on a gurney in the emergency department. Outcomes of LP procedure under these settings are more likely to be less than desired as compared to when the procedure is carried out electively, in the confines of the office setting, and with the physician well-rested and not rushed for time.