Aug 23, 2018
Do you spend time finding out what the “why” is for your patient?
Have you considered it’s not what is the matter with the patient but what matters to the patient? What the patient thinks their purpose is? Or at the very least, what they wish for during the next part of life, however short that may be?
In this episode American intensivist, Dr Wes Ely, tells us how he deeply cares about the whole patient – the body, the mind and the spirit. He is passionate about really getting to know his patients. And to do that he thinks we need to be heavily focused on both ICU liberation and good listening.
The ICU liberation bit sounds easy. It's removing the patient from the sedatives, the ventilator and whatever other harmful interventions are no longer needed when their situation is improving. But it's harder than we think. And to help with this, he has led the development of the ABCDEF bundle. With the assistance of many colleagues, and based on high quality science, he has progressively developed a simple 6 factor approach that has been shown to speed up ICU liberation and improve patient outcomes. And in this podcast he describes how he uses it, and how you can too.
Listening to our patients also sounds easy. But how many of us spend the time required, and really be there for that person with grace and humility, so we can truly find out what matters to them, and respect their spiritual faith.
Wes will be well known to many of you. He is a Pulmonary and Critical Care specialist who conducts patient-oriented, health services research as a Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University School of Medicine, in Tennessee, USA. He is also a practicing intensivist with a focus on Geriatric ICU Care, as the Associate Director for Research for the VA Tennessee Valley Geriatric Research and Education Clinical Center. His research has focused on improving the care and outcomes of critically ill patients with ICU-acquired brain disease. Wes has built the ICU Delirium and Cognitive Impairment Study Group and his team have developed the primary tool by which delirium and health-related quality of life outcomes are measured, the CAM-ICU. He has over 350 peer-reviewed publications and over 50 published book chapters and editorials.
In this conversation, Wes and I cover many other topics including:
- How he chose medicine after observing family illness as he grew up
- The enjoyment he receives from holding the hands of and looking into the eyes of patients
- How good doctors are not distracted by technology
- A Wall St journal and a CNN.com article he has penned which display his ability to find out what really mattered to 2 of his patients
- The importance of reading - and the 3 types of reading we should do
- How his ICU ward round is patient-centric and heavily nurse-focused
- The need to understand our unconscious biases and to have humility
- The concept of becoming the best version of our selves
- That life balance requires exercise, sleep and healthy eating
- His passion for triathlons, including the ironman
- How he balances family and work
- How his spiritual faith helps him to minimize stress
- His understanding that there is something bigger than us happening around us
- How burnout is simply an imbalance in the fundamentals of life
- The Nietzsche quote “He who has a why to live can bear any how”
- His appreciation of the work of the 3 Wishes Project (links below)
- What happened when he read the Jabberwocky poem (link below) to one of his patients
- His advice that young clinicians should be patient and truthful
- What the mnemonic DR-DRE means to him
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 Wes Ely. I passionately believe we can all get better, both as carers and as people, so we can do our absolute best for those patients whose lives are truly in our hands.
Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. If you wish 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.
Wes Ely is a genuine leader of our specialty and is a wise, philosophical and compassionate doctor with a refreshing spiritual perspective. Please enjoy listening to the podcast.
Andrew Davies
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Show notes (people, organisations, resources and links mentioned in the episode):
Wall St journal article about bringing a swimming pool to the ICU: https://www.wsj.com/articles/a-swimming-pool-in-the-icu-1466117000
This article was published in the medical literature too: https://link.springer.com/article/10.1007/s00134-016-4434-0
CNN.com article about patient Paul: https://edition.cnn.com/2018/03/20/opinions/caregiving-what-its-like-to-be-me-wes-ely-opinion/index.html
The ABCDEF bundle: http://www.iculiberation.org/Bundles/Pages/default.aspx
Lancet article on an RCT of no sedation: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62072-9/abstract
New England Journal of Medicine article on RCT of daily interruption of sedative infusions: https://www.ncbi.nlm.nih.gov/pubmed/10816184
New England Journal of Medicine article on RCT of spontaneous breathing: https://www.ncbi.nlm.nih.gov/pubmed/8948561
Lancet article on Awakening and Breathing Controlled RCT: https://www.ncbi.nlm.nih.gov/pubmed/18191684
Lancet article on RCT of early physical and occupational therapy: https://www.ncbi.nlm.nih.gov/pubmed/19446324
Critical Care Medicine article about the ABCDEF bundle: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830123/
Critical Care Medicine article about a single-centre ABCDE bundle trial: https://www.ncbi.nlm.nih.gov/pubmed/24394627
Critical Care Medicine article about a multi-centre ABCDEF bundle trial: https://www.ncbi.nlm.nih.gov/pubmed/27861180
William Osler: https://en.wikipedia.org/wiki/William_Osler
Dalai Lama: https://www.dalailama.com/
Matthew Kelly: http://www.matthewkelly.com/
Fulton Sheen: https://www.fultonsheen.com/
David Bennett: https://www.rushu.rush.edu/faculty/david-bennett-md
The Merton prayer: https://reflections.yale.edu/article/seize-day-vocation-calling-work/merton-prayer
Friedrich Nietzsche: https://en.wikipedia.org/wiki/Friedrich_Nietzsche
Viktor Frankl: https://en.wikipedia.org/wiki/Viktor_Frankl
Annals of Internal Medicine article on the 3 Wishes Project: https://www.ncbi.nlm.nih.gov/pubmed/26167721
Another article on the 3 Wishes Project: https://www.ncbi.nlm.nih.gov/pubmed/27525361
Poem “Jabberwocky” by Lewis Carroll: https://www.poets.org/poetsorg/poem/jabberwocky
Mother Teresa: http://www.motherteresa.org/index.html
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