Mastering Intensive Care 020 with Jack Iwashyna

Do you play the role of the exemplary leader in the ICU? Are you charming, funny, friendly and extroverted – even when these aren’t your natural personality characteristics? Do you throw yourself into your series of consecutive days in the ICU like you are going away to adventure camp? Do you outline specific objectives that a patient should meet over a timeframe of a few days to decide whether treatment should continue? And how regularly do you talk to your patient’s family when you are pretty sure the patient is dying?

These are some of the questions you may ask yourself after listening to this episode of the Mastering Intensive Care podcast with American intensivist Jack Iwashyna. This is the fifth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Jack is Associate Professor of Pulmonary and Critical Care Medicine at the University of Michigan where he is a practising medical intensivist at both the University of Michigan and the VA Ann Arbor Health System.

He also devotes significant energy to training clinician scientists and is best known for his work defining the concept of “survivorship” after ICU and measuring aspects of the post-intensive care syndrome. Jack’s keynote talk at DasSMACC was entitled “Persistent Critical Illness” and as you’ll hear in this podcast he is the perfect person to talk about this given he does 14 day blocks in his ICU allowing him ample opportunity to understand what happens in the evolution of a patient’s critical illness.

Despite Jack self-proclaiming he is introverted, this episode of the podcast reveals him to be a diverse conversationalist with well-matured thoughts, views and reflections on his own experience about how a consultant intensivist should act, whether that be in throwing ourselves 100% into our clinical service, playing a specifically crafted leader’s role, wisely mentoring less experienced clinicians, regularly communicating to patient’s families, simply having fun doing our job with our colleagues and respecting our spouses and families for supporting the work that we do. We cover a myriad of topics including:

• Jack’s powerful answer as to why he loves his job
• How invigorating it can be to talk to people he has only just met
• How he has previously done 30-day stretches of continual clinical service
• As a researcher he tries not to study his own ICUs too closely
• Our fixation on short-term survival is inadequate for most patient families
• His use and the benefits of time-limited trials of life support
• How he uses a school-like A-F range grading to mark patient’s progress
• The benefits of taking his children away on academic trips
• His somewhat raw reflections about not feeling as good a father and husband as he is a doctor
• The difference between mentoring in research and in clinical practice
• Our role is to try to help all trainees to improve, however good we perceive them to be
• Burnout is a systems issue – where the system is being run too hard
• The importance of sleep and afternoon naps ​

Show notes

• Jack Iwashyna at University of Michigan
• Jack Iwashyna on Twitter: @iwashyna
• DasSMACC
• A Practical Approach to Running a Scarce Resource Allocation Team (SRAT). Jack Iwashyna
• Making RCTs Useful: The Role of Heterogeneity. Jack Iwashyna
• Should we put multiple COVID-19 patients on a single ventilator? Jack Iwashyna

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.

Feel free to 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 andrewATmasteringintensivecare.com.

Further reading and listening

• Full podcast collection on LITFL and Libsyn
• More conversation on Twitter (@andrewdavies66) and Facebook