Pulmonology is the medical specialty dedicated to the diagnosis and treatment of diseases affecting the respiratory system, including the lungs, airways, and chest wall. Pulmonologists, often called lung doctors, are highly trained medical specialists whose primary focus is on internal medicine. The simple answer is that pulmonologists generally do not perform traditional surgery, focusing instead on the non-operative management of respiratory conditions.
Focus on Diagnosis and Medical Management
The core expertise of a pulmonologist lies in the medical management of acute and chronic lung conditions. Their training involves a three-year internal medicine residency followed by a two- to three-year fellowship focused on pulmonary medicine, often combined with critical care medicine. This extensive background prepares them to manage complex diseases using pharmaceutical, rehabilitative, and lifestyle interventions.
Pulmonologists treat a wide range of illnesses, such as chronic obstructive pulmonary disease (COPD), severe asthma, pneumonia, interstitial lung disease, and pulmonary hypertension. They are skilled in interpreting diagnostic tests like pulmonary function tests and complex imaging studies. Their treatment strategies revolve around prescribing medications, managing mechanical ventilation, and developing long-term care plans for patients with respiratory failure.
The Distinction from Traditional Surgery
Pulmonologists do not perform traditional, open-chest procedures like lobectomies or pneumonectomies, which involve making large incisions. Pulmonology is classified as a medical specialty, distinct from surgical specialties like thoracic surgery. The training pathway for a pulmonologist does not include the extensive operative experience required for a surgeon.
The distinction lies in the approach to treatment; a pulmonologist manages disease from a medical perspective, while a surgeon manages conditions that require physical alteration or tissue removal. Their focus remains on pharmacological and procedural solutions that avoid major incisions. Patients requiring major structural repair or removal of large tumors are typically referred to a surgical colleague.
Minimally Invasive Procedures Pulmonologists Perform
While they are not surgeons, many pulmonologists specializing in interventional pulmonology perform advanced, minimally invasive procedures. These techniques are typically scope-based, performed through natural openings or tiny skin punctures, avoiding the need for a full operating room environment. The most common procedure is bronchoscopy, where a flexible tube is inserted into the airways for both diagnostic and therapeutic purposes.
Diagnostic uses of bronchoscopy include:
- Collecting tissue samples (biopsies).
- Performing bronchoalveolar lavage to collect fluid from the lungs.
- Using advanced techniques like endobronchial ultrasound (EBUS) to sample lymph nodes in the chest.
Therapeutically, interventional pulmonologists use the bronchoscope to clear airway obstructions, remove foreign bodies, or place stents. They also perform thoracentesis, inserting a needle into the chest cavity to drain excess fluid (pleural effusion).
When Surgical Intervention is Necessary
When a patient’s condition requires the removal of a lung lobe, a full lung, or major structural repair, the pulmonologist refers them to a thoracic surgeon. Thoracic surgeons perform complex procedures like video-assisted thoracoscopic surgery (VATS) or robotic-assisted surgery for lung cancer. These operations involve removing portions of the lung or other organs within the chest cavity.
The relationship between the two specialists is highly collaborative, particularly in the management of lung cancer. The pulmonologist handles the initial diagnosis and staging using bronchoscopy and EBUS. They then work with the thoracic surgeon to determine if the patient is medically fit for surgery and manage the patient’s respiratory function before and after the operation.