The Dyspnea Clinic
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Healthcare delivery is increasingly divided into subspecialty domains that are often organ specific. This works well for some organ-centric disease states and provides a comfort level for specialists as far as diagnostic approach and therapeutic decision making. However, this may not work well for complaints such as dyspnea. Dyspnea is a common, nonspecific symptom that presents to primary care provider (PCP) and subspecialty offices. Many patients require a thorough diagnostic evaluation to establish the underlying cause, which can remain elusive after a determined evaluation. The patient often falls into the chasm between subspecialists telling the patient it is not their lungs so back to the cardiologist, or it is not their heart and back to the pulmonologist; patients can bounce between specialists for upward of 2 years.1 The time and cost for the evaluation of dyspnea can be significant and frustrating for both clinician and patient.2 It is for these reasons that there is increasing interest in establishing dyspnea clinics (DCs), which are centered on symptoms, rather than on organ systems.
When a patient is referred to a DC, he or she often has had an evaluation initiated by a PCP (Figure). Typically, the PCP (or subspecialist) makes the referral, although self-referrals also occur. DC staff develop a …