Consultant physicians working with patients - Royal College of ...

2 Specialties Respiratory medicineand bronchiectasis are examples of chronic conditionsfor which care is shared with primary care. The BTS haslong supported the British Lung Foundation indeveloping Breathe Easy patient support groups and theCystic Fibrosis Trust in helping patients and familieswith cystic fibrosis.The concept of the expert patient is welcomed,especially to improve care for patients with chronicrespiratory conditions. The BTS greatly values the inputof lay representatives on all of its committees and isworking closely with the Royal College of Physicians’(RCP’s) patient and carer group.4 Interspecialty and interdisciplinaryliaisonMultidisciplinary team workingRespiratory specialists have long worked as a team withcareer-grade doctors, doctors in training, ward-basedand outpatient nurses, and other allied healthcareprofessionals committed to providing high-qualitypatient care, including: respiratory nurse specialists (RNSs) clinical respiratory physiologists clinical scientists physiotherapists psychologists secretaries managers.Examples in which these colleagues contributesubstantially include: specialist clinics smoking cessation advice and support early assisted discharge and pulmonaryrehabilitation services ambulatory and long-term domiciliary oxygen andnebuliser assessments acute and domiciliary non-invasive ventilation(NIV) service for patients with ventilatory failure sleep-related breathing disorders service, includingcontinuous positive airway pressure (CPAP) therapy providing education for patients, their carers, otherhealthcare professionals and the wider community providing an invaluable counselling service for clinical respiratory physiologists, runningdiagnostic and therapeutic lung-functionservices.Working with other specialistsMembers of the respiratory team liaise with many otherspecialties, particularly with histopathology,microbiology, radiology, thoracic surgery, oncology,palliative medicine, public health and social services.Regular meetings with radiological and surgicalcolleagues to review scans and radiographs and todiscuss patient management are common. Close clinicalliaisons have been developed between respiratoryphysicians and colleagues from disciplines in whichmultisystem diseases affect the lungs. These includerheumatology, haematology, transplant services,genitourinary medicine, renal medicine and oncology.Respiratory teams increasingly are developingcollaborations with other specialists, particularlycardiologists, to provide high-quality care for the largenumber of respiratory patients who have multiplecomorbidities.Lung cancer is a good example of a disease in whichrespiratory physicians play a key role inmultidisciplinary teams (MDTs). Most respiratoryphysicians are heavily involved in the diagnosis andmanagement of patients with lung cancer. In 2007, therewere 177 lung cancer MDTs in the 30 cancer networksin England; about 85% of these were chaired byrespiratory physicians, as were most lung cancer-specificnetwork working groups. Other MDTs and networksare emerging for TB, DPLD, COPD and end-of-life care.5 Delivering a high-quality serviceWhat is a high-quality service?A high-quality service implies that all patients receiveprompt, expert, effective and compassionate care, and,with few exceptions, this should be available locally.This requires a well-motivated, well-staffed MDT thathas access to suitable facilities. Patients and otherprofessionals should expect continual access to a localexpert respiratory advice service, so respiratoryphysicians should never be single-handed and workingin isolation.Maintaining and improving the quality of careService developments to deliver improvedpatient careThe resources required for a district general hospital(DGH) to provide a high-quality service aresummarised in Table 1.C○ Royal College of Physicians 2013 227