The Daily Schedule Of A Pulmonologist

Pulmonology is the branch of medicine that focuses on the chest and respiratory system including all the anatomy associated with breathing. Pulmonologists are trained specialist physicians who manage conditions and diseases of the chest such as asthma, bronchitis, pneumonia, tuberculosis and emphysema. Also, pulmonology often involves managing patients who need  mechanical ventilation and life support in intensive care units (ICUs).

Training

A doctor can spend up to 15 years training in order to become a specialist pulmonologist. This training consists of 5-6 years completing their medical undergraduate degree, 1-2 years of an internship phase, 4 years completing the residency programme in internal medicine and 3 years training in a fellowship programme in pulmonology.

A pulmonologist can also sub-specialise in a specific chosen field and they can include the following disciplines:

• Critical care medicine.
• Interventional pulmonology where the specialist performs invasive procedures such as bronchoscopies.

Procedures used by Pulmonologists

The following are procedures and investigations which are requested and performed by pulmonologists in order to aid with diagnosing and managing respiratory conditions and illnesses.

• Blood tests are requested to exclude signs of infection. Arterial blood gas levels are also required, especially in patients who are on mechanical ventilation.
• Sputum specimens are sent away for microscopy, culture and sensitivity (MC&S) tests to analyze for infective sources, cytology for cancer cells and specific MC&S and ZN stain requests for diagnosing tuberculosis. 
• Chest X-rays to visualize any obvious pathology.
• CT scanning is requested when a pulmonologist suspects conditions such as lung cancers, foreign bodies and pulmonary embolisms.
• Spirometry - used to diagnose airflow obstruction by breathing into a dedicated machine.
• Pulmonary Function Tests consists of performing spirometry and administering drugs such as bronchodilators to assess any changes in breathing patterns, lung volumes and the diffusion capacity of the lungs.
• Scintigraphy and other methods of nuclear medicine.
• Bronchoscopy with bronchoalveolar lavage (BAL), epithelial brushing and transbronchial and endobronchial biopsy. The lavage and biopsy specimens are then sent away for analysis to exclude pathologies such as cancers.
• Positron emission tomography (PET scan), especially in diagnosing lung cancer.
• Sleep studies (polysomnography) commonly used for the diagnosis of obstructive sleep apnoea.

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Management of patients

Pulmonologists employ many different management protocols when treating patients with respiratory conditions. These can include the following:

• Medication - antibiotics, inhalational and oral steroids, short and long acting bronchodilators, leukotriene receptor antagonists, oxygen therapy and CPAP machines.
• Pulmonary rehabilitation - this is intended to help the patient live a meaningful life by being able to function as independently as possible in order to live a good quality of life and have a better prognosis. This is done by incorporating exercise, emotional support, education, non-invasive mechanical ventilation, oxygen therapy or support, compliance with medical care in order to reduce the number of exacerbations and hospitalizations, optimal clearance of airway secretions, returning to work and a more active lifestyle. The healthcare workers who are involved here include a pulmonary medicine specialist, a rehabilitation physician, a rehabilitation nurse, physiotherapists, occupational therapists, a psychologist and a social worker.

The Daily Schedule Of A Pulmonologist 

A pulmonologist will consult with their hospital patients that they admit 1-2 times a day depending on their medical condition. These specialists will also consult with patients of theirs in the ICU and any other patients that have been requested for an opinion by other specialists. A pulmonologist will also be asked to manage the respiratory settings on patients who are on mechanical ventilation.

These specialists have their offices situated in the hospital so that they can get to their patients in the wards and casualty department quickly when there is a medical emergency. Pulmonologists also have to be available for on call services after hours and on weekends where they have to provide emergency services for patients with life-threatening conditions. These would include respiratory failure due to acute infections such as pneumonia or acute exacerbations of chronic issues such as emphysema.

Monday

A pulmonologist will deal with the administrative issues related to the office and deal with confirming meetings with hospital staff and management as well as medical representatives. Other important administrative issues will also be dealt with before consulting with patients.

The specialist will then start consulting with patients. The patients will be managed conservatively with medication and referral to physiotherapists, be investigated further by being sent for tests such as chest X-rays and lung function tests or be admitted to the hospital for further tests and management.

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Tuesday

This day can be reserved for performing procedures such as bronchoscopies for visualizing the respiratory anatomy and taking biopsies of lesions that are suspicious. The specialist will then follow up the findings of these biopsies and the patients will be contacted so that the information can be relayed to them and further management of a condition can be discussed.

Wednesday

The pulmonologist will continue to consult with and manage patients in an appropriate manner. This day can also be used for giving an opinion on lung function tests, chest X-rays and CT scans of the chest which have been requested by other physicians such as general practitioners and specialists.

Thursday 

The pulmonologist will consult with patients today as well and manage them as they see fit. 

The afternoon can be used for the training of undergraduate medical students and postgraduate clinical assistants specialising in pulmonology. Ward rounds are done in the ICUs to teach the mentioned students and doctors about using and adjusting mechanical ventilators.

The afternoon can also be used for dealing with clinical administrative issues such as filling in motivation letters for medical insurance companies, completing physical reports for life insurance companies, filling in chronic prescriptions for patients and doing further research for the specialist's own education needs.

Friday

Friday mornings are used to consult with patients and the afternoons are used to finalise any unfinished administrative tasks. Once all the patients are seen and all outstanding issues have been resolved, then the work week can come to an end.

The specialist who is working over the weekend will be responsible for the medical care of their patients and of those of their colleagues.