EPISODE EIGHT｜The World’s Great Doctors with Prof. Rembert Koczulla
2021-12-24 15:19:58Guangzhou Gloryren Medical Technology Co., Ltd51
For the eighth episode of Gloryren’s high-end talk, we are honored to have a conversation with Prof. Dr. Rembert Koczulla, Professor of Pulmonary Rehabilitation, Department of Pulmonology, Philipps-Universität Marburg and Chief of the Pulmonary Department of Schön Klinik Berchtesgadener Land. Prof. Koczulla is the only professor for Pulmonary Medicine in Germany, the founder of the Institute for Pulmonary Rehabilitation Research and also is part of a BMBF Project Covid/post Covid. In the interview, Prof. Koczulla shared with us his unique opinions on some hot topics, for example, when the pandemic will end and how should the Covid-19 patients do during the phase of rehabilitation.
Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in Pulmonary Rehabilitation?
Doing or being a medical doctor was my dream since childhood times. I started university time in Berlin, and I went to the US and also to the Netherlands. First, I started with a kind of internal medicine, and pulmonology was just that I was very interested in. I saw a lot of patients suffering from pulmonary problems. I was always, since childhood and since starting university career, I was interested in science. In the university where I did my first pulmonology education, I had the opportunity to do a lot of scientific work, so I stayed with the pulmonology. You ask me why I then went to the rehab part. I did a lot of intensive care medicine. The rehab here is something which is not the classical rehab. That means rehab here has more severe patients, and the intensive care education just had me taken up. Here we see a lot of transplant patients, we see a lot of patients before transplant. At the moment, we see a lot of Covid patients.
How did your early youth experience shape your success?
There is a nice story. When I was a little boy, I injured my eye. I was fascinated by the doctors who had me just to keep the opportunity to see and to have that sense of seeing. So I recovered from that injury and I was fascinated by medicine. I think that's one of the parts which inspired me to come to the field of medicine.
Who have been you greatest influences? What have they taught you and how have they inspired you?
There were some teachers that influenced me of course at medical school. But the person who influenced me most during my medical career was Claus Vogelmeier. He is a specialist in chronic obstructive pulmonary diseases. He was kind of my father figure in medicine. But there were also some really prominent educators, like Denton A. Cooley from the heart surgery in Houston, Klaus Rabe, Pieter Hiemstra and Peter Sterk where they were the influences during my time at the Netherlands.
There are not many W3 professors in Pulmonary Rehabilitation. How did you feel when you obtain the professorship at the University of Marburg?
It is a big honor to be the only professor for Pulmonary Medicine in Germany. And of course it is also a position that has a lot of responsibility for future structures. There's also the demand of developing something which helps to bring the field forwards. So I like to structure that, I like to develop that. It is just a nice feeling to see that we’ve achieved quite a lot in the last 4 years.
How do you balance the personal life, administration, clinical practice, research activities and lecturing?
I see a lot of patients, and I am doing rounds quite often. I also have a major parts in the diagnostics. The balance between the lectures and the clinical setting, it's sometimes difficult. So we have some lecture weeks here. That means we have the students here for a week. I also travel for the lectures in Marburg and in Salzburg. The research is part of the daily business. We will check every patient if he/she can be part in a specific study. We have a lot of parallel running clinical studies in our department. We have a special setting that the patients stay here for at least three weeks that gives you a lot of opportunities for scientific questions. That's the reason why we run so many studies here. For the basic science, we have the collaboration with the Marburg where I have some employees that help to answer that scientific questions.
Could you please share one case that you think as the most challenging and impressive one?
We have a lot of challenging cases, since we see a lot of severe patients in pulmonary medicine. But one of the most challenging in the last couple of weeks was a patient suffering from post-Covid. He came in a really bad shape, but later was able to enter the stairway of the plane himself and went back to his home country.
You have been an active member of a number of leading organizations or societies in the field of pulmonology; how has this helped to shape your career?
I think the networking based on society context or in the society is a major part of developing network systems for clinical and for scientific questions. It is increasing your success, increasing the quality of your work by using these systems. So I think it's mandatory to have that kind of networking, for example, joining some societies.
The COVID-19 pandemic is one of the biggest challenges facing modern healthcare. What impact do you see this having on the field of Pulmonary Rehabilitation?
You're completely right. The pandemic was challenging. But by just coping the pandemic again, the networking between the pulmonary departments increased. I have the impression that there was a lot of exchange of knowledge. It was possible also from the standing of the field of pulmonology that changed during the pandemic. It was mandatory to have respiratory physicians included in the conferences and the political decision making. There was a lot of advising also for the politicians by respiratory physicians. So I think that our position and the great field of medicine increased during the pandemic.
When do you think the Covid-19 pandemic will end?
For that question, I've prepared something. Do you know what it is? It's a crystal ball, and you know all the witches try to get something out of the crystal balls to read something inside. But no kidding, I do not know. I think for sure some months, the pandemic, especially during winter time, will let us suffer, because we know that the aerosols during a higher humidity state and during the winter times, are bigger dangers. So I would guess that it probably decreases in spring. At the moment, in Germany, the numbers of infected patients increase. We are nearly as high as last year during that time. We see a lot of infected patients which were not vaccinated. We started the third vaccination for specific patients, but at the moment, the numbers have increased during the last couple of weeks. I would guess that the post-Covid problems will just be present for at least a couple of months, since we know that symptoms can be cured over a long time period. That means over weeks, over months in the post-Covid field, I would guess that the next year also will bring us a lot of patients suffering from post-Covid. So I would guess that the acute infection goes down, let's say, at spring; and the post-Covid problems will maintain to at least on the end of the next year.
In order to fully regain their health and to avoid reinfection, what advice would you give to those Covid-19 patients during their recovery phase?
I think, first of all, we need a personalized approach. That means we just have to get all the symptoms of the patients. We have learned that they can require a lot. Of course, we see patterns. But my first advice is a personalized approach. That means besides the diagnostics, and if you turn into therapy, and we do not have a lot of advice and evidence for the pharmaceutical therapies. Just to get more evidence based medicine in the pharmaceutical part of the post-Covid treatment. We need to understand better the physiology and part of the physiology of the disease. For the non-pharmaceutical part, we know that rehab bring some success, but also there we need a personalized approach. That means we have to check what can the patient, what does the patient able to do, where we can get him? And where we can bring him? For that, we start more slowly than before we started for those patients who are deconditioned. So I think that's a major difference. You have to keep in mind that also the fatigue or the chronic fatigue syndrome can be a problem. Just taking it all together. My advice is to make a very individualized plan for the patient, a therapy plan based on the broad diagnostic which probably is based on the symptom complex of patients.
The World Health Organization (WHO) lists four lung diseases among the top ten causes of death. What’s your opinion on this and how can international collaboration contribute to this issue?
I think that the respiratory physicians, and the rank of the respiratory physicians in the field of medicine is underrepresented so far. Just based on what you just cited, that means, we know, for example, pulmonary infections and the COPD that increase over the next couple of years, and will become one of these, as you mentioned, leading causes of death. For that time, we need the scientific networking and we need the prevention. That's very important. For example, in the field of COPD we have to prevent by limiting cigarette, smoking and also vaping, but also the environmental problems that we have to decrease. Then we can hope that for the future generations, perhaps these diseases can be decreased. I think, preventing, networking and scientific approaches to become better and the field of drug delivery should be a major point.
What advice would you give to someone hoping to start a career in Pulmonary Rehabilitation?
I think just to cover the whole range of pulmonary rehab. For me, pulmonary rehab starts at the ICU and also on the other side, starts in the prevention. You should be broad educated. The ICU experience and the specification and intensive care medicine was ahead for me just to cover that part of the very severe disease patients. For me, it is also very important to combine always the 3 columns. The university education, including the lecturing, the clinical approach and the scientific approach. These three parts should be taken together, and that gives you a very interesting, a very demanding, but also a very fascinating field of medicine. I like that quite a lot and so I can recommend to be part of that rehab society.
What would you have been if you had not been a medical doctor?
My mother wanted me to become an actor. So I spent some time in active practicing in theater and acting little roles in the school theatre.
What are your hobbies outside of practicing medicine?
I'm interested in cultural stuff. That means theater, cinema. I'm very interested in music, I like listening to music quite a lot. I also like soccer playing, tennis playing, and skiing, snowboarding, so all the things you can do in the mountains.