35 - Paul Wischmeyer - Never underestimate the simple things we do to our patients

How did your patient feel that time you took several attempts to place a CVC?

What might happen after a dose of haloperidol for delirium?

In this compelling episode, Professor Paul Wischmeyer, shares some of his experiences as a patient in the ICU. Since he was 15 he has endured multiple hospitalizations and ICU stays for his inflammatory bowel disease. This has given him an excellent vantage point to notice what we as ICU professionals do and say to our patients. And from Paul's perspective we could do much better. Some of the procedures we might think are simple (like placing intravenous or intra-arterial cannulae) can cause significant suffering. And if we treat these procedures as something just to tick off on our list we may diminish the person-centred care we should all be attempting to deliver.

Paul's passion for helping patients recover from illness and surgery arises from his personal experiences as both a doctor and patient in the ICU. As a trained intensivist, anaesthetist, clinical pharmacologist and research scientist, he works predominantly as a Perioperative physician who specializes in enhancing preparation and recovery from surgery and critical care at Duke University. He practices on the Critical Care and Nutrition clinical teams, serves as the Director of Perioperative Research for the Duke Clinical Research Institute, as Associate Vice Chair for Clinical Research in the Department of Anesthesiology and as Director of the Nutrition Support Team. Paul has been awarded significant amounts of funding, won many awards, published over 135 papers and given hundreds of invited presentations.

Five days ago Paul tweeted he was back in hospital so I thought it was a good time to bring this interview we did a few months ago. I'm hoping he is much better today and that he'll be out of hospital and back home very soon.

Paul has a lot of valuable things to say in this interview. We also spoke about:

• How in the early part of his career he loved the physiology and pharmacology but now he loves the family interactions and teaching
• Learning from people all around the world makes him a better doctor
• How his personal experiences have helped him to use more sedation in his practice
• Our need to get away from the concept of keeping a patient quiet with sedatives so we can have a peaceful night in the ICU
• The effects on his mother of a child psychiatrist asking her about her parenting in the work up of Paul's illness
• His reflections on the difference in ward rounds between his current and previous institutions
• His views on having a close partnership between intensivists and the palliative care team, especially in family meetings
• The importance of body position and body language in communication
• How he feels less healthy in a system of 12 hour shifts for intensivists because scheduling self-care can be difficult
• The anxiety he notices when he doesn't exercise
• His views on a good diet and the supplements he takes
• His need to feel ready to be hospitalised at any time due to his illness
• The benefit of having a good department chair who helps him say no to too many responsibilities
• How he deals with feeling overwhelmed
• The importance of staying well-hydrated during our work
• His main points about giving a great lecture, including the use of images and developing the skill of inspiring or convincing the audience with emotion
• Some tips for younger clinicians, including being open minded, keeping up with the literature and focusing on connection to patients

My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Paul Wischmeyer. I genuinely believe we can all improve, as both professionals and as human beings, so that we can do the absolute best for the people we are privileged to care for as patients.

Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com.

Thanks for listening.

Andrew Davies

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Show notes (people, organisations, resources and links mentioned in the episode):

Paul Wischmeyer profile: https://scholars.duke.edu/person/paul.wischmeyer

Paul's webpage on Duke Clinical Research Institute website: https://dcri.org/our-work/therapeutic-expertise/perioperative-nutrition/

Twitter handle for Paul Wischmeyer: @Paul_Wischmeyer

Book: "Presentation Zen Design" (by Garr Reynolds): http://www.presentationzen.com/presentationzen/2010/02/presentation-zen-design-the-book.html

Book "In Shock" (by Dr Rana Awdish): https://www.ranaawdishmd.com/book

TARGET study: https://clinicaltrials.gov/ct2/show/NCT02306746?term=TARGET+nutrition&type=Intr&cntry=AU&city=Adelaide&rank=1

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com

Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care

Twitter handle for Andrew Davies: @andrewdavies66

Instagram handle for Andrew Davies: @andrewdavies66

Email Andrew Davies: andrew@masteringintensivecare.com