Respiratory diseases belong to internal medicine or surgery

The vast majority of common respiratory diseases belong to the category of internal medicine (specifically, respiratory medicine). Only a small number of respiratory-related diseases that require surgical intervention belong to surgery (generally, thoracic surgery). There are also some special cases that involve other departments such as otolaryngology and infectious diseases. There is no absolute boundary division.

Last week I was helping out at the outpatient consultation desk, and I met a young man who had been coughing for almost two weeks. He stood in front of the registration machine for ten minutes and finally registered for the thoracic surgery department. When he was called in, the doctor asked and found out that it was just ordinary bacterial pneumonia without even pleural effusion. He directly issued a transfer order and asked him to go to the Department of Respiratory Medicine. After taking antibiotics for ten days, he was completely cured after a review. Later, the young man came to tell me that he had searched online and found that if the pneumonia was serious, he needed surgery. He was so frightened that he immediately refused surgery, which was a minor mistake.

Why is there this confusion? To put it bluntly, the scope of the respiratory tract is too wide, from the nose, pharynx, and larynx, down to the trachea, bronchi, alveoli, and to the surrounding pleura and mediastinum. Problems in these parts can be considered respiratory-related diseases. Twenty years ago, when grassroots hospitals were not yet subdivided into departments, these problems were all under the control of the internal medicine department. That is to say, in the past ten years, minimally invasive technology in thoracic surgery has become popular, and departments have become more and more detailed, so the parts that require surgery have been classified into the scope of surgery.

And if we really want to be honest, there are many fuzzy areas in this division, and there is no unified standard in the industry. For example, if it is the same lung cancer and has not metastasized in the early stage, thoracic surgery is the first choice. If it is in the advanced stage and cannot be operated, the respiratory medicine or oncology department will do conservative treatments such as targeted and immunological treatments. There are also pulmonary nodules that are very common nowadays. Some hospitals are accustomed to allowing patients with lung nodules smaller than 8mm and small shapes to be treated. Patients with regular nodules should be followed up in the Department of Respiratory Medicine. If the nodules have burrs and are highly suspected of being malignant, they will be transferred to the surgical department for evaluation. In some hospitals, as long as the nodules are pulmonary nodules, they will be checked by the thoracic surgery department first. There is no problem with either treatment method, but the diagnosis and treatment habits of different hospitals are different.

There are also some more special cases, such as allergic rhinitis, acute tonsillitis and other upper respiratory tract problems. Many people do not associate them with respiratory diseases at all, and go directly to the otolaryngology department, which is absolutely correct; if it is infectious respiratory diseases such as tuberculosis and influenza, they have to be transferred to the infectious disease department or a specialized infectious disease hospital for treatment, which has nothing to do with internal medicine and surgery. I met an old man with chronic obstructive pulmonary disease a while ago who insisted on applying for a thoracic surgery appointment. He said that he knew Dr. Li from the thoracic surgery department when he had a gall bladder a few years ago. As a result, he was kicked out by Dr. Li with a smile: "There is no use in looking for me for your breathing problem. Go to the respiratory medicine department and see Dr. Wang. She is more professional than me."

In fact, for ordinary people, there is really no need to debate whether respiratory diseases belong to internal medicine or surgery. If you really feel unwell and have common symptoms such as cough, sputum, fever, and wheezing, you will definitely not make a big mistake by going to the respiratory medicine department first. Even if you need surgery in the end, the doctor will transfer you to another department. If you have already taken a CT scan and it is clear that there are masses or nodules, or if you have chest trauma or pneumothorax, which is too painful to move, you can go directly to the thoracic surgery department. If you're really not sure, it's much more reliable to ask the doctor next to you when you register than to search on Baidu for half an hour.

By the way, many hospitals now have multidisciplinary outpatient clinics for respiratory diseases. If it is a relatively complex problem such as lung cancer or interstitial lung disease, you can directly call the multidisciplinary department. Doctors from the Department of Medicine, Surgery, Radiology and Pathology will work together to make a plan for you, which saves you the trouble of changing departments yourself. In the original medical treatment, there is no need to draw such a strict boundary between medicine and surgery. The most important thing is to be able to solve the problem.