A pulmonologist is a doctor who specializes in the lungs and respiratory tract (trachea, bronchus, diaphragm, etc.). When to go see it? How is a consultation carried out? What price ?
A pulmonologist is the doctor who specializes in lungs and lung diseases. What is its concrete role? Why go see him? How does a consultation with a pulmonologist take place? How much does a pulmonologist cost?
What is the role of a pulmonologist?
The pulmonologist is a specialist in pulmonology, a medical specialty that covers lung diseasesbut also the respiratory tracts. The lungs are among the most important organs of the human body. They can therefore be affected by many pathologies, whether directly or indirectly. “It goes from simple asthma to lung cancer, passing through infectious diseases, sleep apnea or any disease causing lung problems“, explains Dr. Jean-Baptiste Stern, pulmonologist at the Institut mutualiste Montsouris in Paris. The pulmonologist must therefore have great knowledge in general medicine. This is why some decide to specialize, for example in interventional pulmonology (which consists for example in removing a foreign body in a bronchus) or in sleep pneumology (to cure sleep apnea for example).
In addition to the lungs, the field of pulmonology encompasses all the respiratory tracts: the bronchi, the trachea, the diaphragm, but also the pleura. These are two layers that wrap around the lungs, called the visceral pleura and the parietal pleura. Lung conditions can affect anyone (some doctors specialize in caring for young children) but there are some known risk factors for causing lung problems. It is obviously smoking (active, but also passive) and exposure to certain substances in the workplace.
When to see a pulmonologist?
“This specialty is quite broad, since it encompasses many pathologies, explains Jean-Baptiste Stern. It can be consulted for example in case of:
- Chronic bronchitis
- Asthma
- Infectious diseases (tuberculosis, pneumonia, lung abscess, etc.)
- Rheumatological diseases that are accompanied by lung problems
- cystic fibrosis
- Respiratory disorders related to systemic diseases (vasculitis, connectivitis, sarcoidosis, etc.)
- Neuromuscular diseases with respiratory symptoms.
It is also able to diagnose and treat cancers of the lungs, bronchi or pleura. Finally, this specialist can also take charge of sleep disorders, such as apnea or snoring. The pulmonologist must therefore know medicine in a very broad way.
Faced with which symptoms should a pulmonologist be consulted?
“Generally, before consulting, we ask the opinion of our attending physician. He is the one who will refer the patient to a pulmonologist“, explains the specialist. But certain respiratory signs should alert and may justify a consultation directly with the pulmonologist, especially in places where general practitioners are overbooked:
- A persistent cough
- coughing up blood
- Chest pain that persists.
The pulmonologist can also do tests to diagnose asthma or chronic bronchitis. These are called respiratory function tests, and consist of taking measurements of the breath by measuring the level of oxygen and carbon dioxide.
► At the start of the consultationthe professional does a medical examination to the patient. “ATAt the beginning of the consultation, the patient is asked about his habits, explains the pulmonologist, in particular to know if he is a smoker or if he is exposed to dust. For example, there are people who work tar without a mask, this can expose them to lung diseases“, details the specialist. Then, the doctor asks the patient about all the other diseases the patient has, “diabetes, blood pressure and cholesterol are the basic triad, for example, people with diabetes are more likely to get respiratory infections“, he specifies. The doctor must also check that the patient does not have a heart problem, or does not take a drug (for example often those which lower blood pressure) which causes coughing: it is a frequent reason for consultation.
► Once the practitioner has knowledge of all the patient’s history, he questions him on the symptoms that led him to consult : “if there are several symptoms, what are they exactly, when did they start…
► “Then we quickly move on to imaging: we generally do x-ray and scanner“, explains Jean-Baptiste Stern. If there is a radiological anomaly or if the patient is coughing up blood, the doctor can carry out additional examinations such as a fibroscopy of the bronchi. Performed under local anesthesia, it makes it possible to view inside the lungs by introducing through the nose or mouth a flexible tube with a camera, named fiberscope. Some pulmonologists also practice new examination techniques, for example ultrasounds of the bronchi, which make it possible to diagnose small lung lesions. This is called an endobronchial ultrasound (Endobronchial ultrasonography or EBUS). Following all these examinations, the doctor can make an initial diagnosis and prescribe medication if necessary.
What should you bring to your pulmonologist?
The most important thing is not to forget tobring your medical file, so that the pulmonologist has as much information as possible about the patient’s history and current health. Even old chest x-rays can provide useful information.
What is the price of a consultation? Is it reimbursed?
The price of a consultation depends first of all on the examinations carried out by the specialist. If there is an EFR (pulmonary function test) or fibroscopy to be done, it will cost more than a simple X-ray. However, all these acts are reimbursed by Social Security at 70% if you have followed the coordinated care pathway (if you have gone through your GP before). Otherwise, you will only be reimbursed up to 30%. Please note, if your professional is approved for sector 2, he may practice exceeding fees, but you will only be reimbursed on the basis of a normal consultation, always at 70% if you have followed the coordinated care course and 30% otherwise. If you have mutual insurance, it will reimburse the rest according to the rates in your contract. Before choosing your doctor, it is therefore better to check your sector and prices.
What studies to become a pulmonologist?
To become a pulmonologist, you must start by following medical studies after obtaining his baccalaureate (preferably scientific). After the 6 years of common core, the medical student must pass national ranking tests. The classification of these tests allows you to choose the desired specialty and the place of exercise: the better you are placed, the more likely you are to have the specialty you want. To be a pulmonologist, you have to choose residency in pulmonology. This lasts 4 years. At the end of these four years, the student will obtain a diploma of specialized studies (DES) in pulmonology, but it’s not over yet: the last step to take to carry the title of doctor is the doctoral thesis. After defending his research thesis, the student is officially a doctor of pulmonology.
Thanks to Dr Jean-Baptiste Stern, pulmonologist at the Institut mutualiste Montsouris in Paris.