In the outpatient practice, we provide consultative care and most patients already have a general or primary care provider who is the "quarterback" for the patients' overall care. Typically patients are referred by a primary physician for a specific respiratory symptom, radiographic abnormality, or unknown disorder. The consultation maybe for ititial evaluation and diagnosis, for Pulmonary Functioning Testing (PFT), bronchoscopy, for charactization of severity and clinical course, and for initial therapy. The pulmonologist typically works closely with the patient's primary care provider. Of course, a patient does not need a formal referral by a physician to be seen in the pulmonary clinic. In general, the detailed impressions and recommendations from an initial visit is promptly shared with the referring doctor and arrangements are made regarding further care and issues of co-management.
In a typical office visit, all prior outside records are reviewed, a detailed history and examination is obtained from the patient (and family). Typically we perform a chest x-ray and breathing measurements in the office on the initial visit (unless the patient brings a copy of recent studies). The office breathing measurements (pulmonary function studies or spirometry and other measures) are fairly simple and routine. If you are on breathing medications let your nurse know prior to the study.
Based on the specific reason for the consultation, some patients may undergo additional testing including a bronchoscopy. This is a procedure that is performed under "conscious sedation" with a major goal to inspect the breathing tubes, obtain specimens, etc.