No Gap Too Wide

“Bridging the Gap” featured North Shore University Hospital Director of Advanced Lung Disease and Pulmonary Hypertension

Interstitial Lung Disease, Arunabh Talwar, M.D., as guest speaker. The event brought together more than 30 health-care thinkers and clinicians from in and outside the Touro community to engage in discussion on how to more comprehensively approach PAH, which arises when blood pressure rises in the valves leading from the heart to the lungs and occurs disproportionately among women and non-Hispanic blacks.

“There’s a big gap between what’s going on in research and what’s going on in the field,” says TouroCOM Director of Continuing Medical Education Remiluken Odunsi. “So we brought people together to create awareness and to emphasize [that] early detection is the key. Physicians need to suspect the condition and test for it. All too often Pulmonary Arterial Hypertension is discovered in the late stages.”

One component addressed during “Bridging the Gap” was disparities in access to proper care and basic health education among different demographics. Minority groups, who tend to suffer most from illnesses such as PAH, often have more limited access to medical resources, perpetuating the incidence of disease in their communities. 

“There may be some cultural bias,” acknowledges TouroCOM Clinical Dean Dr. Kenneth Steier. But, he adds, “There’s a myriad of factors, mostly because it’s very subtle and gradual in onset, so even the patients don’t realize problems they’re having from it. There’s also just the difficulty in visualizing, people don’t often think of it. It’s a little bit underappreciated and under-recognized.”

The goal, then, is two-fold: for those currently practicing to find a middle ground between enhancing their diagnostic procedures without putting added strain on their own resources, and to grasp readily adaptable methods they can share in the classroom. “Even a busy physician in practice could order the appropriate tests if they think of the possibility of the disease,” confirms Steier. “And certainly, to pass it along to future-physician students and interns and residents is great because of how many patients they’ll see in the future.”

Though there are a number of sophisticated laboratory tests used to make the diagnosis, one must first have PAH in mind. One concrete test recommended by Dr. Talwar is what’s known as the “six-minute walk,” where the patient takes a slow, guided walk down a 50-100-foot hallway, allowing a pulmonologist or cardiologist to first track potential signs of PAH. Dr. Steier and his colleagues were all inspired by Talwar’s demonstration, which offers a non-invasive and simple way to introduce PAH testing into an initial office visit.

“We all looked at each other at the table and I said, ‘How many of us actually do that?’” recalls TouroCOM Basic Biomedical Sciences Chair Dr. Tipsuda Bahri. “It’s a great idea, and there are exercise tests and walk tests where you just have the patient walk a certain amount of time and see if they have increasing shortness of breath. So if you are limited with time, the walk test is something you can try to incorporate into your work-up. And Dr. Talwar mentioned it’s always important to consider that as part of the physical exam.”

Ask anyone who was there, and they’ll agree that the gap between awareness of PAH and adequate clinical attention to it is capable of shrinking. And the hope is that TouroCOM students will benefit from a more holistic approach to not just the science of PAH, but its socio-economic implications, helping ensure it doesn’t linger under-assessed. In a sense, the thinking goes hand-in-hand with the fundamental, theoretical underpinnings of osteopathic medicine.

“We always encourage our students to look at the more common conditions, but also think out of the box,” says Dr. Bahri. “If [a] person has a very unique presentation and you’ve ruled out everything else, this may be a condition that you haven’t put on your list. With osteopathic medicine, they look at the person from the moment they walk into that room, so the observation starts with their posture, the way they’re breathing. If someone may have pain, it may be psychological. That’s what we’re trying to instill in our students−−look at the forest, but do spend a little more time to look at the individual trees.”