We have a silo problem. I do not mean silo-filler’s disease, which some of you may see clinically but most of us simply see every 10 years around board review time. I mean the tendency—not unique to health care—for us to be hemmed in by the artificial divides we have created. We separate activities by specialty, section, division, department, and the like. We create barriers to care, an us-vs-them mentality, and duplication of services. The silos simply need to come down.
In this issue of CHEST (see page 436), Yarmus et al1 have given us a hint about the direction we need to take. By using a procedure that is classically outside of their specialty, percutaneous endoscopic gastrostomy (PEG) tube placement, they have helped us see how a focus on patient need leads to safe delivery of services that improve efficiency and decrease costs. Their step with a minor, minimally invasive procedure shows the way to a major impact. Taking a collaborative approach, they were able to streamline the delivery of feeding tubes to a select patient population. Having navigated a similar route, I can tell you that their efforts are far from trivial. They required significant diplomacy and collaboration in broaching the subject of introducing a new procedure to their armamentarium, receiving proper training, surmounting reflexive opposition, and educating those resistant to the approach about the benefits to the patient and institution. I commend Yarmus et al1 and those who had the open minds to allow them to pursue this route.