Development and Maintenance of a Pleural Disease Service

Role of the 'Pleurologist'

Kelsey Cameron, PA; Dana Teodoro, PA; Azam Kasis, MBBS, MRCP; Matthew Evison, MD, MRCP


Semin Respir Crit Care Med. 2019;40(3):297-304. 

In This Article

Abstract and Introduction


Changes in the health care environment, increasing specialization, and the use of ultrasound have led to pleural diseases being managed by a select few. This article aims to look at the impact of current medical education paradigms, service structure, procedural education and role of the "pleurologist" in providing care to patients with pleural disease.


The health care environment is experiencing many shifts and changes, with many forces influencing the landscape. The prevalence of new subspecialties, restrictions on work hours, and awareness about the effect of complications and medical errors on patients are significantly impacting health care delivery and medical training. Trainees and recent graduates may have less exposure to managing certain diseases and performing some procedures that are increasingly performed by specialists. This is true when it comes to pleural disease. This is an area of medicine that in the past would have been managed by an internal medicine physician or pulmonologist, and this included procedures on the pleural space such as thoracentesis and intercostal drain placement. In this new era there are physicians who have a special interest in pleural disease or are interventional pulmonologists with formal training in it. With the advent of this specialized care, we aim to discuss what it takes to develop and maintain a pleural disease service, including who should perform pleural procedures, outcomes based on operators, education models for pleural procedure training, the role of different team members on a pleural disease team, and the components and institutional structures needed to support it.