“The patient is always right”

On Monday 13th March several of the student panel members were privileged to have the opportunity to attend the annual King’s College London Halliburton lecture, given by Professor Moxham. Professor Moxham is known for his work involving respiratory physiology, including respiratory muscle weakness, neural respiratory drive, breathlessness, ventilatory failure, non-invasive ventilation, and pulmonary rehabilitation. The lecture we attended on Monday, titled, “Physiology to improve Patient Care,” centralised around the idea that through bed-side research, breathlessness has not only been better understood, but will be further understood in the future.

The lecture began with an introduction by the Professor, where he told us that his interest in physiology arose during his work with RF Armstrong. He had been continuously measuring the cardiac output and blood oxygen levels by the bed-side and he told us he had, “found this very fascinating”. Several years later, he began his work in the field of respiratory muscle with Professor Richard Edwards, described to us as “an inspirational man.” He also talked about his past trip to Montreal where people examined changes in the EMG power spectrum and this allowed him to learn how to assess diaphragm strength.

This led to his work in trying to discover, “How to measure respiratory muscle weakness?” And he informed us that it is bed-side research which is essential to understanding this. He reported to us that the methods currently available for doing this are assessing maximum mouth pressure and oesophageal pressure. Professor Moxham explained that it was essential to find non-invasive ways to do this because in the instances where patients are unable to express their symptoms of breathlessness, we must rely on the medical equipment available to us, to allow us to understand the condition of the patients and help these patients.

He later presented to us what seemed to be the key theme of the lecture. “Breathlessness is the drive, and the drive is breathlessness.” At this point, the majority of the panel members struggled to understand this, but after the lecture Vicky explained to us that Breathlessness is the symptom where a patient is struggling to breathe, and drive is the “short term for neural respiratory drive, which is the traffic that the brain sends down to the breathing muscles (mainly the diaphragm, but also the intercostals and some other muscles) to tell them to contract.” She helped us understand that throughout the lecture, the Professor had explained that they key causes of this symptom of breathlessness are various diseases such as COPD, obesity and asthma. He concluded the lecture with the idea that when patients described breathlessness, it is not that it is not present if a doctor cannot see/measure it, the problem is that we have not discovered a way to measure the breathlessness, and hopefully through bed-side research the future doctors will understand that “the patient is always right” and that when they describe the symptom of ‘breathlessness,’ this is able to be seen with advanced medical equipment.

Although this was a challenging lecture for the student panel members to understand, it was both intriguing and enjoyable. We were introduced to a concept by Professor Moxham that we are all excited to further hear about in the future.

By Neta Fibeesh and Ma’ayan Dee, Student Advisory Panel members, JFS School (Year 11)

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