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To the Editor: In their article on clubbing, Drs Myers and Farquhar¹ imply that "advanced" and "early" clubbing might be used as quantitative terms. However, the terms to describe the clubbing are not standardized. Should we just use early and advanced (does early clubbing mean that it will become advanced with time?) or grade the clubbing like heart murmurs? It might be useful to have some standard rather than, for example, "present" or "absent," or "acute" and "chronic." Once present, does clubbing often go away? I have seen clubbing in a patient with lung cancer and when the cancer was "cured" with surgery, the clubbing disappeared only to return with recurrence of the tumor.

Lawrence Scharer, MD
Pulmonary/Critical Care Division
St Luke's/Roosevelt Hospital Center
New York, NY

1. Myers KA, Farquhar DR. Does this patient have clubbing? JAMA. 2001;286:341-347. FREE FULL TEXT

In Reply: Although we agree with Dr Scharer that the terms used to describe clubbing are not standardized, it was not our intention . . . [Full Text of this Article]

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Does This Patient Have Clubbing?
Kathryn A. Myers and Donald R. E. Farquhar
JAMA. 2001;286(3):341-347.
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