So the thing about pulmonology is that it’s surprisingly hand-wavey and vague for being the study of organs that are not called “the brain”, “the soul”, or “the liberal arts and humanities.”
And I get that most of medicine is actually pretty hand-wavey. But, look – the definition of COPD, straight from our lecture slides? “Persistent post-bronchodilator FEV1/FVC < 0.7 not due to diseases other than COPD.” It’s like they’re not even trying to hide it.
I guess a more textbook definition of COPD would be something like “Either chronic bronchitis or emphysema or usually both, actually, with a variation in spectrum from “blue bloater” to “pink puffer”, which we no longer actually think correlates to ‘bronchitis’ and ’emphysema’ respectively, even though that would make it easier, wouldn’t it? Turns out there’s actually no association. Tell your attendings next year!”
COPD is probably too easy to pick on, though. There’s also good stuff like Interstitial Lung Disease, which is an umbrella category of many different diagnoses that affect the interstitium, about half of which have “idiopathic” in their name (definition: “Why? Because… LATIN. That’s why.“).
As our lecturer that day stated, “Generally, students have trouble learning these diseases, because they expect to understand them.” (Indeed. I really feel like when Robbins calls something a “wastebasket diagnosis”, hope is dead.)
Anyway, I actually love pulmonology (fairly straight-forward! Cool diseases across the life-span! And… um – look, I really just want a handheld electronic spirometer. Regardless of my specialty. It clicks and prints and whirrs! Who needs an ipad?) So no, I don’t blame them for not being particularly keen on the idea of taking biopsies of living lungs.
I just think it’s fun to see that psychiatry isn’t alone in its uncertain and somewhat-manufactured-by-necessity diagnoses.