1. First, could you please tell us a little bit more about yourself and how you discovered your passion for your medical career?

Hello to everybody. It's a great pleasure to give this interview to you. My name is Gernot Marx, I'm the Head of the Department of Intensive Care at the University Hospital RWTH in Aachen, Germany. And my department comprises 100 ICU beds and so we're looking after many critically ill patients. It has this university hospital which completely has got 1500 beds and 34 different disciplines, including transplantation and looking after burned patients. So it's basically the complete picture of intensive care. I'm 57 years old. I'm married. I've got two children. They are already adults and themselves now. My son is 21 and my daughter is 19. Basically, I started to think about a medical career during my school and the last year of my school when I thought (about) what I wanted to do in life and I was reading and discussing with friends and family a lot. And my goal was to invest my life to something valuable. So then I came to medicine. Having said this, no one in my family has got medical background, so I'm the first doctor in my family. And after finishing school, I've done some civil service for nearly two years and there I was an ambulance driver working in an ambulance and performed emergency care and during these twenty months, basically, I was sure that this was the right decision, and then I studied medicine. In Hannover, at the Hannover Medical School, and graduated there and did my MD thesis and my PhD equivalent and started to be then my career as an anesthetist and intensivist.

2. At what point did you start seeing Anesthesiology, Intensive Care and Emergency Medicine as somethings you could be really great at?

Yeah, thank you for the question. Let's say I was already primed during my time before I started studying medicine, when I did this ambulance and emergency job. But finally, my decision was done in my fourth year at university. Because we can start our MD thesis already during our university time. And at that time, I started my MD thesis in Anesthesia and Intensive Care. And at that point of time, it became clearer and clearer that this is the right specialty for me.

3. Is there any person(s) who inspired you to pursue your career in Medicine, to be specific, in your specialties?

Yes, there is one specific person in my life. There are several afterwards, but the most important person was my MD supervisor. He was also an anesthetist and was the consultant of the ICU. At Hannover, at this university, and basically he inspired me because he was fascinated by the potential of Intensive Care Medicine and what you can do for patients and let's say he infected me. So there was a lot of spirit and he really taught me how to do it very properly. He was my teacher, basically, not only for the MD thesis, but also for Intensive Care Medicine. And basically he showed me how to do, and when I started after university in Anesthesia also I was with him for my first year and then he was very important teacher for me. And basically he gave me a lot of input, which I now can transfer to others to my team and others afterwards when I moved to Liverpool and to Jena. I had different professors there and all those had many important input for me and I learned from their positive sights. But also I could learn that something they performed was not my way. So I basically developed through all this different experience at the different universities in Hannover, in Liverpool in the UK and also in Jena in the east of Germany. Many experiences could create the base I can now benefit from.

And concerning your answer, Juin would like to share with you about the settings in China and the situation in China. In China we also have MD students and a supervisor guiding him or her to finish their studies, and during the guidance the teachers normally would rely more on the admin work. They spend most of their time doing the admin work and spend less with guiding his or her students. So Juin would like to know about your thoughts on this kind of way of teaching. Do you have any recommendations? 

Well, obviously I also have got many tasks as a manager in my department for the hospital, but it's important to save some time that you basically organize yourself that there are specific time over the week schedule for teaching, and you need to prioritize them very highly because in the end of the day it is very important to transfer your own experience and your passion to the young generation. Because it needs to not only get on, but we need to get better always and make the most of the potential of digitization and AI and all the rest, and therefore our young generation needs good teaching from experienced teachers.

4. What motivated you to get involved in the Intensive Telemedical Care, specifically, the establishment of Virtual Hospital that radiating your state or the whole Germany?

Yes, and it's exactly fifteen years ago I started my job here as head of department in Aachen. So it was 1st of November 2008. And RWTH Aachen is a very famous university for Technology, is one of the places of excellence university for Technology and Medicine, obviously. And during this period I came across some scientific articles from our neurologists, and they have started in the early 2004 or 2006 a stroke network with Telemedicine. And when I read this, I thought, well, this is good for the neurology patients, but when you do, you need to transfer these effects, these positive effects, to all critically ill patients and you need to establish a telemedical ICU network. And, so we started with pilot projects and it grew over the time, and now we're doing it more than ten years. And finally, we convinced also our regional government and they established this Virtual Hospital in North Rhine-Westphalia, so, our region here to connect hospitals and other doctors to patients and that we have really a digitized health care network, the Virtual Hospital. So this implies not only Intensive Care, but we started with Intensive Care, but also other indications like Oncology or infectious diseases.

5. How would you describe the benefits to patients for establishing such a Virtual Hospital for intensive care consultation in the current setting?

Yes, this is a very good question. So the main issue is that we share 24/7 the highest level of experience and knowledge in the University Medicine with basically everybody else, with all the colleagues from the peripheral hospitals, so a patient wherever she or he is, can have access to our support, (and) our experience. And we have done several randomized controlled prospective studies and we have shown that the adherence to guidelines is significantly higher that we treat more specifically according to guidelines like Antibiotic Therapy, a diagnosis of infectious diseases. And we had a better outcome in severe septic, (and) septic shock patients. Also, the treatment of Acute Respiratory Distress Syndrome was significantly higher. And when we moved then towards the corona pandemic, we basically increased our services and we could show that the survival of ventilated, severely ill COVID-19 patients was much better compared to the national average. So I think this is the most important point (which) is sharing expertise and knowledge 24/7. So whenever support is needed we are there. And we do this advice only with team members who are very experienced, who are experienced intensivists and have years and years of clinical experience.

So normally for a patient, for a doctor or a nurse joining your network, they would accept the guidelines and then how long could they be adjusted to use it? And how? 

Well, usually basically what we do is that we make several telemedical consultations. So on average between six and seven consultations (a week). So basically it's day by day or sometimes several times a day. And then we see how the patient is reacting to our advice and to the therapy and then we adjust and adjust, it's basically like a patient on our own units.

6. The field of Anesthesiology, Anesthesiology, Intensive Care and Emergency Medicine has a wide spectrum and many injuries and diseases should be treated jointly by different disciplines. How is multidisciplinary collaboration organized at your hospital?

So it is really (orientated), our hospital is very much orientated into this multi-disciplinary collaboration. This is basically our spirit. And looking at the Intensive Care Medicine in my department, I have seven different units. And we can treat critically patient on all units, but each unit has, let's say, a specific core competence, like Trauma or Cardiac Surgery or Neurosurgery or others. And what we do is that we do common rounds with our colleagues from the Surgical Departments, for example, and that this is at least one common round per day, quite often two. We have also one specific person, a consultant from each other department, who is our contact person. So when we have over the day or overnight a problem, we contact this particular person and he or she comes then to the unit and we discuss how we can proceed and and treat patients better when there is a problem or whether you need surgery or a specific diagnostic procedure. And also from the different departments, we have young trainees who train a time in my team and that they learned how to act as intensivist. So they basically learn very intensively how to recognize when the patient deteriorates and what needs to be done so when they are then back in their own departments, that they have better knowledge and can better identify these patients on normal wards. And also what we do is obviously when we have a specific issue like Ophthalmology or correlation problems and then we have also consultations to these specific departments who are present always at our University Hospital day and night.

7. What qualities should a clinical specialist like you possess to be successful in fulfilling the obligations in your hospital, in teaching in the university and in holding major positions in a variety of European societies?

Yes.Well, what you do need is a high intrinsic motivation and some strength, basically, because obviously all these obligations need a lot of input and also time and effort. And you need some motivation and an idea that you must like to shape the future, to bring innovations to the patients, to improve the care of patients. And also you need to have some scientific curiosity and that you are not satisfied with the situation like it is in the present. But yet you want to make it better, basically. And I think this motivation and that you want to move forward, this is very important to get the motivation to fulfill all the obligations which is then required. Also, you need to have some sort of strategic ideas and plans, (like) how to get there, and (it is) not only for yourself, you need to share it with others, share your expertise, share your motivation, (to) motivate people and your team. And on motivation, you also need to support them and to demonstrate that this is important and this is valuable and that they really think your way is a good way. And it is not my way--it is our way.To improve and to develop a better medicine, better serve medical service than we have now.

8. Do you have any suggestions to share with us on how to train the young generation (to the Chinese chiefs)? What advice would you give to the young clinicians?

Well, as a person in charge, as one of the leaders you need to be authentic. Your team not only need to listen to you, they need to watch and see that you're not (only) talking, you're also acting like (what) you're saying and that you are really caring, and this is basically something you have to fulfill day by day, so for whatever issue arises. So I think this is very important that you're the real person and you're not having that on a poster or on a PowerPoint presentation, but that you live what you’re saying. And basically, it is about value-based care for the patients and also for your team. So you need to really to listen to (others), (and) have a feel(ing about) what's going on, where you have to step in, and maybe moderate or support (them). And maybe really there might be a specific problem of one of the team members you have to look at. So you have to be really sensitive and whenever you do so, the other team members see and acknowledge that you really care. And this is then creating a very good team spirit. And the challenge for a person like myself is to keep this up over a long time. So when you start with a team it's not easy but doable to improve a team. But to stabilize on a very high level, on an altitude, like crucial altitude for the plans over years, this is really not easy and needs a lot of personal input. And yes, I think this is (my advice).

9. Is there any tricks you would like to share with us on work-life balance?

Yes, well, I have to admit that I probably spend many many hours for work and all the obligations and less for family compared to others. This is probably true. But what I've always done is the time I had with my (family), and even still today, I have with my family then (I would) really focus on the family, so (it means) that you're not at home or doing something with your children and you are basically thinking about work or doing even with the laptop or your telephone something for work, but that you're really there and create quality time with your family members and listen (to them). And also it is important (that you) never stop communicating also with your family. And that you sense also when they need more of you at specific times. So this is very, very important. And yes, this is my trick, so to say.

Yeah, same for us. One thing I have forgotten to be honest is, and I think this is also important, (that) I'm always contactable, (and) reachable for my family so they can ring me or send me a WhatsApp or whatever to be in touch wherever I am, because obviously I'm also traveling quite a bit. And I think this is also very important.

10. What are your hobbies during your leisure time?

Well, I do like my sports, so I'm cycling, I'm running, I'm swimming a lot. And also during holidays I like to be in the nature. So in the mountains or you know, traveling as always, there is a lot to see, and see(ing) wild animals and just being out there also bring back a lot of strength and power. So this is where I relax and fill my batteries up, basically, yeah.