Dr. Shannon Carson ’85 says he was eager to explore when he was a Caldwell Fellow and a student in biological sciences at NC State. Since then, he’s been exploring improvements in public policy for critical care patients. Director of the Pulmonary and Critical Care Training program at the UNC School of Medicine, he helped shape the current standards for critical care in the U.S. while a fellow at the University of Chicago. He spoke with NC State magazine intern Anqi Li about his career and his experiences as a Caldwell Fellow and Student Body President.
My father was a college track coach. I would hang around the track meets, and I got interested in what the athletic trainers were doing. That piqued my interest in the biological processes of the body. I can’t think of anything else I would rather be doing.
Your research focus is critical care, particularly prolonged mechanical ventilation. Why?
I attended medical school [at UNC-Chapel Hill] during the worst of the AIDS epidemic, before antivirals were around. A lot of young people were coming in with severe lung infections related to HIV infection or AIDS. I got interested in pulmonary disease based on exposure to so many of those diseases; and pulmonary diseases and critical care are tied together. [Prolonged mechanical ventilation] patients present a particular challenge because they have survived very devastating illnesses, yet recovery is not guaranteed. . . . I conduct health services research and clinical trials related to patients with critical illness. Those patients are of special interest because they are a challenging group of patients who require critical services, but have difficulty recovering to the point where life sustaining therapies are no longer necessary. So, their disease burden is high, their burden of symptoms of suffering is high and the degree of resource utilization is high.
What do you hope to contribute through your research?
What I hope to contribute are ways to ease the critical course for these patients, either by preventing chronic critical illness, shortening the time required for prolonged mechanical ventilation or improving communication between health care providers . . . and the families of these patients, for whom the prognosis is often rather poor. Physicians are not always skilled in communicating poor prognosis and these patients present a particular challenge because they have survived very devastating illnesses, yet recovery is not guaranteed. For many patients it’s very unlikely. So, communication around prognosis and expectations is spectacularly challenging, so we’re working on ways for physicians to be more confident in making prognoses, and then working on ways on how to educate them to communicate those prognoses in a clear manner.
You have traveled with the American Thoracic Society several times in the last five years. What kind of work do you do with them?
I’ve had the opportunity to participate in courses for physicians in developing nations in South America [and] Africa and to help them design clinical studies that will have more relevance to their patients. Developing nations are very limited in terms of resources to conduct medical research. So, research on clinical conditions is conducted in wealthy nations. A lot of the research questions aren’t relevant to [developing countries] because wealthier nations use drugs that aren’t available there. Also, the diseases are different. For example, the most common cause of chronic obstructive pulmonary disease in the U.S. is cigarette smoking, but in Africa, it’s exposure to biomass because all the meals are cooked in small, unventilated huts on cooking fires that burn wood or dung. The clinicians in those nations need to learn how to study disease in their own environment so they can rely more on their immediate conditions and experience, rather than relying entirely on the Western literature. . . . The interaction with physicians and researchers from these varied cultures has been particularly rewarding. I have two children, and I was able to take my oldest to one of the courses in Africa last year. I feel fortunate to have had the opportunity to expose him to the needs of the developing world at an impressionable age.
How has your experience in developing countries helped make you a better doctor?
Watching how the clinicians there have to operate and intervene, it reminds one of the basic importance . . . physical exam skills that you learn in medical school, and how they can be very effective. [In the U.S.], we’re often distracted from the basics by the technology . . . we have here. It does help one as a clinician reaffirm the basics of physical diagnostics. . . . As a researcher, it helps by giving me a sense of how the studies that we do . . . should . . . not always remain focused on an interesting biological issue, but how important it is to approach research questions that are going to ultimately have a broader impact of the system.
How did your experience as a Caldwell Fellow benefit you?
It introduced me to students who were active within Student Government and to faculty who were involved in university policy. Interacting with them helped me come to terms with my own leadership potential and gave me the confidence to run for Student Body President. [The year I was Student Body President] was when [student government] started the legal aid clinic and when legislation was coming through regarding raising the drinking age. So I was able to channel my interests in public policy and public service through that office, and that has impacted my research and helped me refine my research interests. For example, my research still . . . leads in that direction, in that a lot of the issues that I study — resource utilization and critical care for example — have direct impact on public policy decisions.