Joining Forces for Patients with Lung Disorders
This article originally appeared in the Summer 2015 issue of Brigham and Women's magazine.
Initially, David* was merely annoyed by his persistent cough. When the cough worsened and was accompanied by wheezing in his chest and difficulty swallowing, David visited his doctor for a diagnosis. Unfortunately, David’s doctor was confounded. Test after test—even a biopsy—could not confirm his exact problem.
After months without answers and tens of thousands of dollars spent on diagnostic testing, David and his doctor grew frustrated. It seemed there was little more to do other than repeated blood work and scans, hoping that something identifiable would surface soon.
However, genetic testing could have detected an inherited form of a disease called bronchiectasis—a swelling of the airways that progressively worsens over time. All along, the key to David’s diagnosis was buried in the family medical history forms he filled out months prior to his first appointment.
It may seem simple, but sharing a single patient intake form across clinical, surgical, and research structures is revolutionizing how patients with lung conditions receive care at the Lung Center at Brigham and Women’s Hospital (BWH).
“We know this type of effort is transformative,” says Bruce Levy, MD, chief of pulmonary and critical care medicine and co-director of the Lung Center. “By bringing together our lung providers here at the Brigham, we can provide individualized care for our patients.” He adds, “In David’s case, all it really took was a shared understanding of his history.”
Along with its predecessor institutions, BWH has contributed to important medical milestones in lung care. Anesthesia was administered in childbirth for the first time in 1847 at the Boston Lying-In Hospital. In 1929, the Peter Bent Brigham Hospital helped introduce the world to the Drinker respirator (or iron lung), which successfully saved a young polio patient’s life. In 1990, 10 years after BWH officially opened its doors, a team of surgeons participated in the first wave of successful lung transplants.
This long tradition of paradigm-shifting discovery lays the foundation for BWH’s newest Center of Excellence. Opened this spring, the Lung Center is a unique collaboration between the hospital’s surgical and medical lung practices.
Individually, the Division of Thoracic Surgery and the Division of Pulmonary and Critical Care Medicine are ranked among the top such programs in the country. Bringing together their renowned physicians, surgeons, scientists, nurses, and support staff, the Lung Center is set to accomplish even more in advancing patient care.
“We have an amazing collection of specialists,” says Raphael Bueno, MD, chief of thoracic surgery and co-director of the Lung Center. “Bruce and I realized that if we want to offer the best care for patients with a variety of lung disorders, we needed to add a new dimension of collaboration throughout all our program areas.”
Reaching across a dozen disciplines—including pathology, radiology, anesthesiology, radiation and medical oncology, otolaryngology, precision medicine, and nursing—the center creates an integrated, seamless experience for patients with lung conditions.
“Our goal is to deliver extraordinary care for any lung condition—from asthma, to cystic fibrosis, to rare lung cancers like mesothelioma,” says Bueno. “We are bringing more than 30 clinical and research programs under our scope. Combined with our academic setting, it is one of the most ambitious centers of its kind.”
The urgency for comprehensive yet specialized care in this arena is clear; diseases affecting the lungs are among the leading causes of death worldwide, and are likely to remain a significant problem for decades to come.
Few know this better than Bill Rudolf. In 2008, Rudolf went to a hospital in his native New York City for elective surgery, and was shocked to learn he had lung cancer. He was even more stunned when a surgeon at a prominent cancer center there told him he was not a candidate for surgery.
“Thankfully, I found my way to Dr. Bueno, who said he could do the surgery to remove my left lung,” says Rudolf, who also credits his successful treatment to Bruce Johnson, MD, a thoracic oncologist at the Dana Farber/Brigham and Women’s Cancer Center. “Now, I’m six years cancer free, which is remarkable given that lung cancer causes more deaths than the three most common cancers [colon, breast, and pancreatic] combined.”
Thousands of patients like Rudolf, who come from all corners of the globe with every conceivable lung condition, can expect the latest advances in prevention, diagnosis, and treatment at the Lung Center. The center is also organized so when patients, after traveling long distances to see a pulmonologist, learn they will need surgery, they can meet with their surgeon that very same day.
“We believe our patients ought to have same day care,” says Bueno. “It’s unacceptable to have them come here just to turn around and wait another month between visits. Our goal is to make their experience as patient-friendly as possible.”
Meeting of the minds: Raphael Bueno, MD (center left), gathers with Lung Center physicians.
In addition to being more convenient for patients, eliminating multiple visits and appointments helps speed their recovery. To further enhance the patient experience, the Lung Center is enlisting patient navigators to help patients take advantage of every support service. Patient navigators help orient patients and families to the hospital by accompanying them to appointments and testing.
“Walking around this hospital for the first time can be very daunting,” says Levy, adding that for patients and families, navigating healthcare can be an emotional journey. “Our focus is on establishing that personal connection, and helping patients and their families through experiences that can be very scary for them, like surgery.”
Having an accommodating care team can make all the difference for patients when they are feeling most vulnerable. For Rudolf, equally important was the knowledge that despite the odds against him, his surgeon was on his side.
“If I had listened to that other specialist, I firmly believe I would not be here today,” Rudolf says. “Dr. Bueno saved my life."
As the Lung Center widens its focus on the patient experience, it is also expanding the world’s knowledge around lung disorders and treatments.
“When you have a complex condition, you look for whoever can provide treatment for your problem,” says Bueno. “Here, we don’t accept no for an answer—we will do everything we can to take care of this community, and that includes the community of patients with rare or orphan diseases.”
Solving the mysteries of incurable or rare lung disorders can be exacting in traditional healthcare settings, requiring the expertise of dozens of niche specialists and a full array of diagnostic tools. In partnership with the Channing Laboratory for Network Medicine, the Pulmonary and Critical Care Medicine and Thoracic Surgery Divisions have joined forces to create a Lung Research Center at BWH’s Brigham Research Institute. The Lung Research Center is fostering early-stage investigation with the same innovative approaches the Lung Center is using in its clinical practice. For starters, the common patient intake form can double as a rich data source for investigators for those patients interested in contributing to the research database.
“The common form’s main function is to simplify information flow between our clinical lung practices,” says Levy. “But a secondary benefit is how much it helps to enable and empower biomedical research.”
Using one form for all thoracic and pulmonary patients who wish to participate in research streamlines the data collection process for Lung Research Center investigators. When linked to an electronic medical record, this ultimately leads to faster discovery of treatments, and even cures for lung disorders.
“We can start to ask questions about risk factors, heredity, and clinical impact with a precision that would be very challenging if there wasn’t a unified medical record,” says Levy.
This collaborative workflow also provides fertile ground for physician-scientists to make life-altering discoveries in lung medicine.
“The people are fantastic here. It’s a great place to learn, work, mentor, be mentored,” Levy says of BWH. “It is a place that develops outstanding scientists as well as physicians.”
A powerful legacy, a clear vision, a team of brilliant minds, and a solution-rich environment. With these strengths alone, the Lung Center is poised to transform how people with lung disorders are cared for well into the 21st century.
“As we move further into health care reform, the Lung Center exemplifies an environment in which everybody is working together to ensure the best possible care for patients," says Ron Walls, MD, executive vice president and chief operating officer at BWH. "And it achieves that in the most efficient and effective way possible."
“I am deeply beholden to Brigham and Women’s Hospital,” says Rudolf, “and I believe this comprehensive Lung Center is a unique concept in healthcare that can help many more patients like me in the future.”
*The patient's name has been changed to protect his privacy.