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Medical Students / Training

Things you need to know about pulmonologists

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A pulmonologist is a doctor who diagnose and treat medical conditions involving the respiratory system.

A primary care doctor can refer someone to a pulmonologist if they show signs of a respiratory condition. Infections such as pneumonia and chronic diseases such as chronic obstructive pulmonary disease (COPD) and asthma include these.

This article addresses what pulmonologists are doing, what conditions they are treating and more.

What is a pulmonologist?

A pulmonologists
A person who has a medical condition that affects the respiratory system should visit a pulmonologist.

A pulmonologist is a physician who is trained in the respiratory system. The system includes all tissues, airways, and muscles that carry oxygen out of the body and extract carbon dioxide.

The respiratory system is specifically composed of:

  • nasal cavity
  • mouth
  • throat, or pharynx
  • voice box, or larynx
  • trachea
  • lungs
  • bronchi
  • bronchioles
  • alveoli

Pulmonologists treat and diagnose respiratory problems that result from:

  • infections
  • inflammation
  • structural irregularities
  • tumors
  • autoimmune conditions

Other respiratory conditions can also affect the cardiovascular system including COPD and interstitial lung disease. Symptoms such as chest pain and breathing difficulties occur in both cardiovascular and respiratory conditions.

Because of this, pulmonologists also work closely with cardiologists when they diagnose and treat certain conditions.

Pulmonologists also coordinate treatment plans for patients with interdisciplinary health care teams that include physicians, nurses, pathologists, and respiratory therapists.

Types of pulmonologist

Pulmonology is a subspecialty of internal medicine or pediatrics dedicated specifically to the study of the respiratory system and the management of breathing disorders.

Pulmonologists may further specialize in their practice by treating only specific conditions or by concentrating on certain groups of patients.

Pulmonology Subspecialties include:

  • critical care medicine
  • sleep-disordered breathing
  • interstitial lung disease
  • obstructive lung disease
  • interventional pulmonology
  • neuromuscular disease
  • lung transplantation

What do pulmonologists do?

In order to diagnose and monitor a number of respiratory conditions, pulmonologists perform various tests and procedures. These procedures cover:

Imaging tests

Pulmonologists use imaging techniques to analyze the different lung and chest structures. Such tests can identify any structural abnormalities that cause respiratory symptoms in a person.

Pulmonologists, for example, might use the following imaging tests:

  • Chest X-rays. These take images of the lungs. Pulmonologists use chest X-rays to monitor overall lung health, looking for infections such as pneumonia or lung masses such as cancer.
  • Chest CT scans. These provide more detailed X-ray images of the chest and lungs. Pulmonologists can detect signs of emphysema, lung cancer, and pleural effusion using chest CT scans. Pulmonologists also use the scan results to plan their next steps.
  • Chest ultrasound. These use soundwaves to produce images of the structures inside the chest and the pleural space, which is the area between the lungs and the chest wall.

Pulmonary function tests

Pulmonary function tests measure various aspects of respiratory health including volume of the lungs, absorption of oxygen and inflammation in the lungs. The findings of these tests are used by pulmonologists to help them identify respiratory problems and control current treatment effects.

Several measures of the pulmonary functions include:

  • Spirometry. This is the most common type of pulmonary function test. It measures lung capacity and the rate for airflow in and out of the lungs.
  • Lung volume tests. These measure the volume of air in the lungs when a person inhales and exhales.
  • Pulse oximetry. This measures oxygen levels in the blood.
  • Arterial blood gas test. This estimates the levels of oxygen and carbon dioxide in the blood.
  • Fractional exhaled nitric oxide test. This measures the nitric oxide content in a person’s breath. Having high nitric oxide levels usually indicates asthmatic inflammation in the lungs.

Sleep studies

In order to diagnose obstructive sleep apnea, pulmonologists who specialize in sleep-disordered breathing conditions may perform sleep studies.

A sleep test, or polysomnogram, tracks the brain and muscle activity of a person as they sleep, as well as their eye movement, heart rate, and respiration rate.

Biopsies

A pulmonologist may conduct a biopsy to extract a sample of lung or pleura tissue, which is the membrane that surrounds the lungs. Lung and pleura biopsies may show signs of inflammation, infection or cancer.

What conditions do they treat?

Pulmonologists can view a wide array of medical conditions affecting the respiratory system. They range from diseases and chronic immune conditions to cancer and advanced deficiencies.

Pulmonologists sometimes treat these as follows:

  • Asthma. This is a chronic condition in which airways are limited by inflammation, causing wheezing, shortness of breath, and coughing.
  • Bronchitis. This applies to inflammation and swelling of the bronchial tubes due to viral or bacterial infections and irritant contact, such as dust, chemical contaminants, or smoke from cigarettes.
  • COPD. This includes progressive conditions such as emphysema and chronic bronchitis, which damage or block the airways and air sacs in the lungs. Although smoking is the leading cause of COPD, up to 25% of people with this condition do not have a history of smoking, according to the National Heart, Lung, and Blood Institute.
  • Cystic fibrosis. This is an inherited condition wherein the body produces thick, sticky mucus that can clog the lungs, airways, and pancreas. People with cystic fibrosis have a higher risk of developing persistent lung infections.
  • Emphysema. This is a part of COPD. This condition damages the walls of the air sacs in the lungs, which can cause the air sacs to collapse or stretch beyond their normal capacity.
  • Interstitial lung disease. This refers to a group of conditions that cause scarring, or fibrosis, of the lungs. Fibrosis makes the lungs less elastic, which makes it difficult to breathe.
  • Obstructive sleep apnea. This occurs when a person repeatedly stops breathing for at least 10 seconds during the night. People with sleep apnea may also experience chronic snoring, daytime fatigue, and difficulty concentrating. It can also lead to other complications, such as depression, high blood pressure, or heart attack.
  • Occupational lung disease. This refers to several respiratory issues that occur as a result of long-term exposure to irritating or toxic substances in a work environment. Substances that can cause occupational lung disease include asbestos, crystalline silica, mold, and chemical fumes.
  • Pulmonary hypertension. This condition causes abnormally high blood pressure in the arteries that supply the lungs. Pulmonary hypertension typically develops as a result of other underlying conditions, such as blood clots in the lungs, emphysema, heart failure, or liver disease.
  • Tuberculosis (TB). This occurs when Mycobacterium tuberculosis bacteria get into the lungs. TB can cause persistent coughing, chest pain, and coughing up bloody phlegm. Although infection rates are relatively low in most developed countries, TB is one of the top 10 causes of death worldwide, according to the World Health Organization (WHO).

Education and qualifications

Pulmonologists must meet the following instructional requirements:

  • a 4-year undergraduate degree
  • a 4-year medical school degree
  • a 3-year residency in internal medicine
  • a 2- or 3-year fellowship in pulmonology
  • specialized training in critical care or sleep medicine

Upon completing their fellowship and any additional training, pulmonologists must pass Board certification exams. When they earn their certifications they will officially begin their work.

Summary

A pulmonologist is a medical doctor specialized in the diagnosis and treatment of respiratory problems including, but not limited to, emphysema, bronchitis and TB.

A primary care doctor may refer someone to a pulmonologist if they have recurrent or worsening respiratory symptoms such as breathing difficulties, chest pain, or a cough that lasts longer than 3 weeks.

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Medical Devices / Diagnostics

Telemedicine: Uses, benefits, and disadvantages

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Telemedicine is a method by which medical care is provided remotely, usually through video chat. Telemedicine offers a variety of opportunities for patients and health care providers alike.

A wide range of treatment options can be accessed via telemedicine services, including consultations with primary care, psychotherapy, physical therapy and even some emergency services.

Read on to read more about telemedicine’s benefits and disadvantages.

What is telemedicine? 

Video chat is one method of providing telemedicine.
Video chat is one method of providing telemedicine.

Telemedicine uses digital devices such as computers and smartphones to deliver healthcare. Telemedicine uses video-conferencing in most cases. Some providers however choose to provide care through email or telephone messaging.

Many people use their usual healthcare provider for telemedicine. Others use a dedicated telemedicine app to access the virtual care.

Telemedicine may be used by doctors and patients for:

  • assess whether or not the patient needs treatment in person
  • provide certain kinds of medical care, such as mental health treatment and assessments for minor infections
  • write or renew prescriptions
  • offer certain types of therapy, such as speech and physical therapy

Telemedicine is effective in cases where the patient needs to exert physical distance or is unable to physically visit a healthcare facility.

Benefits

Evidence finds that telemedicine works widely, even for severe medical conditions.

A 2017 meta-analysis and systematic review of telemedicine use in treating chronic heart failure, for example , found benefits. These included lower admission rates, shorter stays in hospitals and less deaths.

The following sections will discuss some of the potential benefits for patients and healthcare providers.

Benefits for patients

Telemedicine has the potential to help treat a range of medical conditions. When a person seeks care from a qualified physician, it is most successful and provides clear details of their symptoms.

Some other benefits of telemedicine include:

  • Lower costs: Some research suggests that people who use telemedicine spend less time in the hospital, providing cost savings. Also, less commuting time may mean fewer secondary expenses, such as childcare and gas.
  • Improved access to care: Telemedicine makes it easier for people with disabilities to access care. It can also improve access for other populations, including older adults, people who are geographically isolated, and those who are incarcerated.
  • Preventive care: Telemedicine may make it easier for people to access preventive care that improves their long-term health. This is especially true for people with financial or geographic barriers to quality care. For instance, a 2012 study of people with coronary artery disease found that preventive telemedicine improved health outcomes.
  • Convenience: Telemedicine allows people to access care in the comfort and privacy of their own home. This may mean that a person does not have to take time off of work or arrange childcare.
  • Slowing the spread of infection: Going to the doctor’s office means being around people who may be sick, often in close quarters. This can be particularly dangerous for people with underlying conditions or weak immune systems. Telemedicine eliminates the risk of picking up an infection at the doctor’s office.

Benefits for healthcare providers

Healthcare providers who offer telemedicine services may gain several benefits, including:

  • Reduced overhead expenses: Providers who offer telemedicine services may incur fewer overhead costs. For example, they may pay less for front desk support or be able to invest in an office space with fewer exam rooms.
  • Additional revenue stream: Clinicians may find that telemedicine supplements their income because it allows them to provide care to more patients.
  • Less exposure to illness and infections: When providers see patients remotely, they do not have to worry about exposure to any pathogens the patient may carry.
  • Patient satisfaction: When a patient does not have to travel to the office or wait for care, they may be happier with their provider.

Disadvantages

Telemedicine, however, may not match every person or every circumstance. There are several possible disadvantages to the use of telemedicine over traditional forms of treatment.

The following articles discuss certain disadvantages for patients and health care providers.

Disadvantages for patients

Telemedicine is not an appropriate fit for all patients. Some drawbacks of this kind of treatment include:

  • Insurance coverage: Not all insurers cover telemedicine. Only 26 states currently require insurers to cover or reimburse the costs of telemedicine. However, these laws are constantly changing.
  • Protecting medical data: Hackers and other criminals may be able to access a patient’s medical data, especially if the patient accesses telemedicine on a public network or via an unencrypted channel.
  • Care delays: When a person needs emergency care, accessing telemedicine first may delay treatment, particularly since a doctor cannot provide life saving care or laboratory tests digitally.

Disadvantages for healthcare providers

Healthcare providers may also face certain telemedicine related disadvantages, including:

  • Licensing issues: State laws vary, and clinicians may not be able to practice medicine across state lines, depending on the state in which they hold their license and the state in which the patient lives.
  • Technological concerns: Finding the right digital platform to use can be challenging. Also, a weak connection can make it difficult to offer quality care. Clinicians must also ensure that the telemedicine program they use is secure and fully compliant with privacy laws.
  • An inability to examine patients: Providers must rely on patient self-reports during telemedicine sessions. This may require clinicians to ask more questions to ensure that they get a comprehensive health history. If a patient leaves out an important symptom that might have been noticeable during in-person care, this can compromise treatment.

When is telemedicine useful?

For any condition that does not require laboratory testing or physical examination, telemedicine works well. Some forms of ongoing care can even be offered by telemedicine such as psychotherapy.

When there are barriers to treatment — such as the COVID-19 pandemic, a patient living far from a medical facility, or a patient who is unable to transport themselves — providers may expand the list of conditions they are willing to deal with. For example , a doctor may prescribe antibiotics via telemedicine for a likely infection.

Summary

Telemedicine is a convenient option for people who are not allowed to go to the doctor’s office and those who prefer to stay home. It is critical, however, that patients verify the doctor’s credentials providing treatment.

Remote care can mean the difference between prompt treatment and no treatment at all for people with anxiety about leaving home, chronic medical conditions that make catching infections dangerous, and contagious diseases.

Patients should provide detailed medical information, and should show the doctor any rashes, injuries or other visible symptoms requiring treatment where possible.

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Biology / Biochemistry

Anatomy: Small introduction

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Anatomy is the definition and explanation of living body structures. It is a branch of medicine and biology.

The study of anatomy goes back to the ancient Greeks over 2,000 years. It can be divided into three specific areas: human anatomy, zootomy or anatomy of animals, and phytotomy, which is anatomy of plants.

Animal Anatomy is the study of the human body’s structures. A knowledge of anatomy is fundamental to health and medical practice.

The word “anatomy” derives from the Greek words “ana,” meaning “up,” and “tome,” meaning “a cutting.” Anatomy studies have historically relied on cutting, or dissection, but now, with imaging technology, it is increasingly possible to see how a body is shaped without dissection.

There are two ways to look at anatomy: Massive, or macroscopic, anatomy, and anatomy microscopic.

Gross anatomy

anatomy class
Knowing about anatomy is key to understanding healthcare.

In medicine, the examination of the biological structures visible to the naked eye refers to gross anatomy, macro anatomy, or topographical anatomy.

Gross anatomy studies can require dissection or non-invasive methods. The goal is to collect data on the broader systems of tissues and organs.

In dissection, the scientist is cut open the corpse of humans or animals and examines its organs.

Endoscopy, which incorporates a tube with a camera at the end, may be used to study structures within living animals. Endoscopy is done either through the mouth or through the rectum, and the primary organ of concern is always the gastrointestinal tract.

Less invasive approaches exist too. For example, the scientist may inject an opaque dye into the animal to study the blood vessels of living animals or humans which will highlight the circulatory system while imaging technology, such as angiography.

Techniques such as magnetic resonance imaging (MRI), computed tomography (CT), or x-rays often disclose details about a living body’s inside

During their studies, medical and dental students conduct dissections of gross human anatomy as part of their practical research. They could dissect a human body.

Gross anatomy students would need to know about the main structures in the body.

Human body systems

There are 11 organ systems in the human body: http://www.innerbody.com/

  • The integumentary system, meaning skin, hair, nails, and so on
  • Skeletal system
  • Muscular system
  • Lymphatic system
  • Respiratory system
  • Digestive system
  • Nervous system
  • Endocrine system, which regulates hormone production
  • Cardiovascular system
  • Urinary system
  • Reproductive systems

Although these systems have different names, they all operate interdependently, which means they work together and depend on each other.

Microscopic anatomy

A cell structure
On a microscopic level, anatomy looks at cell structure and function.

Microscopic anatomy, also known as histology, is the study of animal, human, and plant cells and tissues which are too small to be seen with the naked eye.

By looking at the tissue under the microscope, we will learn about the cells’ structures, how they are assembled and how they relate to each other.

Of example, if a person has cancer, microscopic analysis of the tissue will show how the cancer cells are behaving and how they affect normal human tissue.

This usually involves observing tissues and cells using histological techniques such as sectioning and staining, and then analyzing them under an electron microscope or illumination.

Sectioning requires cutting tissue into very thin slices to allow for analysis. Histological stains are applied to biological structures, such as tissues, to add colors or to enhance colors so that when examined, they can be more easily differentiated, particularly if different structures are next to one another.

Histology is important to the understanding and advancement of life science in medicine, veterinary medicine, ecology and other aspects.

Histology is used for:

Teaching: Histology slides are used in teaching labs to help students who are learning about the microstructures of biological tissues.

Diagnosis: Tissue samples, or biopsies, are taken from patients and sent to the lab for analysis by a histologist.

Forensic investigations: The microscopic study of biological tissues can help explain why, for example, somebody unexpectedly died.

Autopsies: As in forensic investigations, biological tissues from deceased people and animals can be analyzed, so that investigators may better understand the causes of death.

Archeology: Biological samples from archeological sites can provide useful data about what was going on in history or ancient history.

Histopathology

Histotechnicians, also known as technicians of histology, histology technologists, biomedical scientists, medical scientists, or technicians of medical laboratories, work in histology labs.

Such experts use special expertise to handle biological tissue samples that may come from patients, from perpetrators whether it’s a forensic laboratory, or from bodies. They prepare tiny slices of tissue, known as pieces, by using a series of techniques. The slices are placed on sheets, and histology stains are applied. A histopathologist, or pathologist, then analyses the slides for interpretation.

A histologist’s skills must be thorough and accurate in producing top-quality samples by histopathologist for analysis under a microscope.

A pathologist is a medical doctor who graduated from the medical school and then, through her residency, specializes in pathology. Residency programs are required for all specialties, and the training is an additional four years for pathology.

They observe cells and tissues and analyze what they see so that they or others can use the data to decide whether someone was injured or died for an injury, and so on.

Histopathology is a Pathology sub-discipline. It is the anatomical examination of tissues and cells affected by disease.

Studying anatomy

Many research related to the health care include training in gross anatomy and histology. Paramedics, physical therapists, occupational therapists, surgeons, orthotists and prosthetists, and biologists all require anatomy information.

Some websites give a “tour” of the human body that illustrates the various organs and how they are constructed. The National Institutes of Health are offering a variety of information regarding the different sections of the body.

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Complementary Medicine / Alternative Medicine

What’s the difference between a DO to an MD?

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Physicians of osteopathic medicine (DO) and medical doctors (MD) are two groups of licensed doctor who can practice medical care in the USA.

All DO’s and MD’s require comprehensive medical study. Many people go to medical schools offering MDs but the popularity of DO degrees is growing.

An MD is a degree in traditional medicine, while a DO uses a holistic, mind-body-spirit approach to care. In the U.S., all types of doctors are issued licenses by the same licensing boards, and they must follow the same requirements for medical practice.

For more detail on the similarities and differences between DOs and MDs, and how it impacts their medical practice, keep reading.

DO vs. MD

Philosophy of care is the main difference between a DO and an MD.
Philosophy of care is the main difference between a DO and an MD.

The main difference between DOs and MDs lies with the treatment approach. DOs use an osteopathic treatment approach while MDs use an allopathic treatment approach.

An allopathic approach relies on modern medicine based on research, and it often uses medications or surgery to treat and control various conditions.

An osteopathic approach to care centers around the entire body. Often DO’s concentrate on preventive care.

A person seeking a DO degree should expect to engage in an additional 200 hours or more of hands-on training on the musculoskeletal system, the American Medical Association (AMA) says.

On the other hand, an MD’s allopathic focus means they adopt a scientific approach to the diagnosis and treatment of individual medical conditions.

Nearly 75 percent of all medical students receive an MD degree according to the AMA.

What they do

Both DOs and MDs can pursue whatever specialties they choose in terms of practices.

However, more DOs than MDs pursue careers in primary care specialties according to the AMA. They found that 57 percent of DOs pursued specialties of primary care in 2018. This covers:

  • 31.9% family physicians
  • 17.8% internists
  • 6.8% pediatricians

In the same year, 32% of MDs pursued primary care, which includes:

  • 12.7% family physicians or general practice
  • 12.9% internists
  • 6.5% pediatricians

A student considering either course, however, does not always need to worry which route to take.

Because both programs lead to licensing, the program a student chooses is starting to become less relevant, according to St. George’s University and the AMA.

In the end, prospective students will consider the school and program in order to determine which one suits them the best.

Education

As for education, MD and DO programs have similar requirements. To attend either program a person needs a very high grade point average (GPA) and a medical college admission test (MCAT) score.

In the 2019–2020 academic year, more than 53,000 students applied for medical schools in the United States.

Of those students, the average MCAT score was 506.1, and the total GPA average was 3.58. Both these averages were slightly higher than those of school years 2017–2018 and 2018–2019.

A student of either program needs to complete 4 years of study once he is in medical school. Their training consists of both scientific and clinical rotational courses.

The main difference is that those studying on the musculoskeletal system for a DO degree need to complete an additional 200 hours of study.

The difference in approach also means the students taking different licensing exams in DO and MD programs. According to the University of St. George, all exams take place in three parts, and usually:

  • The first part comes at the end of the second year.
  • The second part comes during the fourth year.
  • The third part comes during the first year of the student’s residency.

The licensing tests will vary, too. Students pursuing a DO will take the Comprehensive Examination of Osteopathic Medical Licensing, but they may also take the U.S. Medical Examination Licensing (USMLE). Students pursuing an MD are taking the USMLE as well.

Summary

Both DOs and MDs are licensed United States physicians. We require rigorous programs of pursue and residency to receive licensing.

The main difference between the two systems is that DOs practice osteopathic medicine, whereas allopathic medicine is taught by MDs.

In other words, a DO would study a preventive, “whole person” approach to illness in medical school, while MDs are more likely to learn how to diagnose and specifically treat a medical condition by looking at its signs and symptoms.

This does not, however, mean that MD training does not teach a holistic or preventive approach to dealing with medical conditions.

Unlike MD students, DO students will also go through hands-on musculoskeletal training, called manipulative osteopathic therapy.

However, in the end either medical school route will focus on acquiring and using up-to-date medical knowledge and providing adequate medical care. The program which a prospective student pursues will therefore be largely a matter of individual preference.

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