Mastering Intensive Care

Do you say “I don’t know” when you really don’t have an answer? Might seeking that knowledge help your patients? This is just one component of a wonderful conversation I held with Professor Flavia Machado when I interviewed her at the recent DasSMACC conference in Berlin. Flavia is doing a great job at raising the awareness of sepsis globally but her other great job is in running a large Intensive Care department in Sao Paolo, Brazil, where she told me that the resources are quite limited. To deal with this challenge she believes optimal communication is vital. How does Flavia lead her ICU on the issue of communication? She does this (1) by having an environment where her team members can ask important questions, (2) by using the WhatsApp messenger app on smartphones, (3) by teaching trainees using courses on how to break bad news, how to speak with families, and how to deal with doctors who have different clinical opinions, and (4) by saying “I don’t know” when finding the knowledge will help the patient. Fl

How did you feel the first day you worked in ICU? Was it like walking on the moon? So foreign, because you didn’t understand much about the machines, the techniques, or even the words that were being used. That’s what it felt like for me, all those years ago. Thanks to one of my consultants who really “held my hand” on that first day, I was OK, but I wish I could have completed a BASIC course like most resident doctors in Australia (and many other countries) do today when they start their term in intensive care. The BASIC course that those resident doctors now complete is mostly due to the efforts of Charles Gomersall. Over a decade ago, he realised the difficulties these junior doctors had in understanding what the Intensive Care consultants were both talking about and doing, so with a bunch of friends he set up BASIC (The Basic Assessment & Support in Intensive Care) course with the aim to teach participants, over 2 days, to rapidly assess seriously ill patients and provide initial treatment and organ s

Whilst the skills of applying life support and resuscitation take up most of our training, they are relatively easier to master than the skills that allow us to become good at diagnosis, good at communication, and most of all good at being resilient over a whole career so we can satisfactorily work with others and deal with the stress of working in intensive care. Peter Brindley, a Canadian intensivist from Edmonton, thinks that these “human factors” are crucial for us to master, especially in the second half of our careers, when we should be striving to be simply “a good person”. In this episode Peter reflects, tells some stories, and invites us to consider many important topics that will help us become better people. These include reflection, simulation, mental rehearsal, debriefing, dealing with upset people and the feeling of being an “imposter”. Peter is a full-time critical care doctor at the University of Alberta Hospital. He is a Professor of Critical Care Medicine, Anaesthesiology, and Medical Ethics

Do you think your procedural skills are more important than your ability to lead and to mentor? Do you have a department head who talks about your personal wellness with you? How do you maintain and improve your skills in leading a family meeting?   Professor Brian Cuthbertson believes that our non-technical skills, those human factor aspects like leadership, mentoring, communication and leading meetings with patient’s relatives, are more important than our clinical procedural skills as we evolve in our careers. But do we talk enough about them? In this episode Brian discusses several of these important non-technical skills giving some powerful insights as a highly experienced clinician and leader in the field of intensive care. Brian is Chief of the Department of Critical Care Medicine at Sunnybrook Health Sciences Centre and Professor in the Interdepartmental Division of Critical Care Medicine at the University of Toronto in Toronto, Canada. He is also an Honorary Professor of Critical Care Medicine at the

What sort of things do you tell yourself when you are resuscitating a patient? Are you self-critical about your ability to deal with the situation? Is your inner voice so loud that you can’t concentrate on the task? This is a topic we don’t speak enough about in intensive care. The inner dialogue, which can often be very negative, is commonly going on in the background as we do our work. And as Associate Professor Sara Gray, a dual-trained intensive care and emergency physician from Canada points out, it can become louder and more critical as we become more stressed with the situation in front of us (eg. a difficult resuscitation). In this episode Sara talks about how observing the inner voice and trying to make it kinder is a form of self-compassion which can lead to improvements in our performance, thereby helping us to bring the best outcomes to our critically unwell patients. Such self-compassion can also provide the additional benefits of making us happier, more mentally healthy, and helping us to perfor

Is the patient the centre of every action you take in the ICU? Do you exude calm and enthusiastic energy and greet other team members warmly and genuinely? Do you seek pleasure in seeing colleagues grow to become more skilled than you are? These are 3 questions you might ask yourself after you listen to this episode with Professor Julia Wendon, a well respected intensivist from the United Kingdom. Julia gives great advice on how helping people converse with each other, often by picking up the phone and demonstrating good consultant to consultant communication can be really valuable in helping a patient receive the best care. She also outlines exemplary behaviour such as saying hello to the patient, whether they are intubated or not, and then telling them the plan after the ward round review. Julia, from King’s College London in the United Kingdom, is Professor of Hepatology, Executive Medical Director, and a highly experienced intensive care physician. Her appointment at King’s began as a consultant in 1992 a

Do you give feedback to your intensive care colleagues when they do their job well? Have you become overscheduled because you have trouble saying no to new tasks? How well do you listen to the views of the intensive care nurses in your ICU?   The first international guest of the podcast series, Dr Colin McArthur, is a highly experienced intensivist, anaesthetist, researcher, administrator and leader from Auckland in New Zealand. In this episode he reflects on many aspects of his career and gives loads of useful advice about aspects such as giving both positive and negative feedback, learning to say no so we don’t exceed our work capacity, and listening to and respecting the views of the intensive care nurses in our ICUs. Colin is a senior intensive care specialist and past-Clinical Director in the Department of Critical Care Medicine at the Auckland City Hospital in Auckland. He is the immediate past Chair of the ANZICS Clinical Trials Group, with which he has been actively involved since its formation in the

Do you seek the relative at the bedside’s help by asking them their opinion on whether their loved one is getting better or not? Do you even have families at the bedside on your ward round? Do you listen as much as you can in your end of life discussions? Professor Imogen Mitchell, a senior intensivist and Dean of Medicine from Canberra, Australia, sees talking to our patient’s families as one of the privileges of working in intensive care. She is a huge supporter of having families at the bedside for the clinical ward rounds and is a passionate believer in exposing our own vulnerability in family meetings, particularly by listening to the patient and their family’s stories first. Imogen has also consistently placed communication with the multi-disciplinary intensive care team at the forefront of great clinical care. Now as one of the senior women in Australasian Intensive Care, Imogen is also passionate about the gender inequity in intensive care training and also in consultant intensivist positions. She has

How important is the main daily ward round we do each day in the Intensive Care Unit? Is the ward round in your ICU focused and concise? Do you adequately communicate the plans you generate on the ward round to the whole ICU team? John Myburgh, AO, an experienced Australian intensivist, who began his life and career in South Africa, is Professor of Intensive Care Medicine at St George Clinical School, University of New South Wales and Director of Critical Care at the George Institute, Sydney. He has an international research profile and is a Foundation Member and Past-Chairman of the ANZICS Clinical Trials Group. In this episode, John gives a very insightful commentary on how much attention he puts on the clinical ward round as our key tool in intensive care practice. We might do more than one ward round a day but John says the main daily ward round is where it should all happen. Where we try and think about how the patient, with their individual characteristics of life and disease, is actually progressing th

Assoc Prof Dianne Stephens tells the story of how she moved to Darwin, a remote part of Australia, immediately after completing her intensive care training, as a solo intensivist and Director of the Intensive Care Unit. And by working hard, respecting and valuing everyone in the team and by communicating well, she led the development of a positive and happiness–focused work environment where great things have happened over the last 2 decades. Dianne received an OAM (a national award) for her leadership role in the intensive care management of the 20 critically ill Bali bombing victims in 2002. She describes what it really felt like in the moment. Dianne takes us on the journey of her career from when she first began to love intensive care as an intern to recently reflecting that she has never had a day when she hasn’t been excited about going to work. She also describes the need to remain calm when emotions escalate at the bedside; the benefit of noticing changes in colleague’s behaviour to assist them before

Assoc Prof Charlie Corke from Geelong, Australia outlines the importance of optimal communication in helping us arrive at the best decisions for our patients. Charlie is one of Australia’s leading intensivists and has been teaching communication and high quality end of life decision-making since before it was even fashionable. Charlie reflects on how we can communicate effectively, telling us that communication begins with caring, requires deep respect for others, is mostly about addressing the needs of others, and most importantly involves finding out what the patient truly wants. In a wide-ranging interview, Charlie tells us that intensive care is not a place we can “mess up”, that good intensivists are like the Sherlock Holmes of the hospital, that delegation of authority can never be vague, that we need to look after our selves as well as we do others, how bullying can be so counterproductive, and how much better it is to work in an intensive care unit which favours consistency of practice over individual

In this episode Assoc Prof Craig French from Western Health (where he is Director of Intensive Care) and Melbourne University in Melbourne, Australia reflects thoughtfully about many aspects of clinical care including how inspiring a healthy workplace culture can lead to staff enjoyment as well as improved patient outcomes. Craig discusses topics such as: how in intensive care we have become more focused on less is best and that this may lead to clinicians becoming deskilled, how good communication and listening requires not being afraid of silence, the benefits of doing a pre-ward round ward round for planning the flow of the day, how more frequent handovers can be an issue, that we are probably moving towards 24 hourly hospital-located intensivists (which may help work-life balance), engaging well with nursing staff is vital including providing them with clear aims, simple observation of patients and their surroundings can provide an enormous amount of information, ward rounds can’t go too long and they nee

In this episode Prof Jamie Cooper from the Alfred Hospital and Monash University in Melbourne, Australia describes how purposeful management of our own careers is vital for longevity in the field, how research has helped him be a better clinician and some of the habits he thinks are important to having a good life at work and at home. Jamie discusses topics such as: why he the immediacy in ICU made it interesting to him; how as a trainee his older colleagues were warning him about burnout; how the size of ICUs has changed over his career; how the gender imbalance has not; how combining research with clinical medicine has increased his career longevity; how if everyone in a department helps each other, the place will be happier; how ICUs can become too large for a single department head; how caring for multiple patient types extends our career; how building too many things into our lives especially at work is a big risk; how preserving evenings and weekends for family is a must; the importance of regular exerc

In this episode Assoc Prof Neil Orford from University Hospital Geelong in Geelong, Australia describes how he has had to learn key leadership skills, how he values and now teaches communication skills, how he works on his overall life balance and how he has developed an interest in writing. Neil discusses topics such as: how he ended up studying medicine after considering being a vet and a mathematician; how he uses regular reflection to optimise his life balance, concentrating on understanding the number of major projects he is involved in at any one time; how he needed to find good leadership training once he became an ICU director in his 30s; how important skilled communication is and how he has become involved in a communication program which amongst other things uses professional actors; how communication skills can be used in all areas of life; the key characteristics of good clinicians; how he interacts with other team-members on a ward round; use of mobile phones on ward rounds and how important a re

In this episode Prof Rinaldo Bellomo from the Austin Hospital in Melbourne, Australia describes how he has always had an enquiring mind and how he judges himself with respect to his ability to be caring, compassionate, competent, communicative and collegial, both professionally and personally. He discusses topics such as: how an experience as a 5th medical student sparked his interest in intensive care medicine; how intensive care has become more safe as technological advancements have occurred; how he seeks feedback from colleagues; how to give feedback and how it needs to be helpful in nature; what his daily routine is; how being at the bedside is so important to excellent clinical care; how experience has helped him deal with stress more easily but makes fatigue a bigger issue; how doing research is the basis of his stress management program; what his out of work pursuits are and how he'd love to have a 30 hour day. He carefully describes the process he uses in his end of life family conversations and astu

In this podcast Prof John Botha from Frankston Hospital in Melbourne, Australia discusses several aspects of exemplary leadership in the ICU. He talks about why he was attracted to ICU; some of his early mentoring; how to learn from even difficult mentors; how an exceptional ICU environment requires trust, a sense of humour and respect for difference in opinion; the importance of encouraging silence in critical clinical moments; the value of listening; the things out of the ICU that keep him from being stressed; the sense of deep connection to humanity he feels from managing the critically ill; what is required for high quality end of life care; and a method for managing other clinicians who may be more proactive with interventions. This podcast was created to help and inspire intensive care clinicians to improve the care we give to our patients by providing interesting and thought-provoking conversations with highly respected and experienced clinicians. In each episode, Andrew Davies, an intensivist in Melbo

This podcast was created to help and inspire intensive care clinicians to improve the care we give to our patients by providing interesting and thought-provoking conversations with highly respected and experienced clinicians. In each of the following episodes, Andrew Davies, an intensivist in Melbourne, Australia, will speak with a guest for the purpose of hearing their perspectives on the habits and behaviours that they believe are the most important for improving the outcomes of our patients. Things like bringing our best selves to work each day, optimal communication, coping with stress and preventing burn out, working well in a team, and interacting with patient’s families and the many other health professionals we deal with on a daily basis. The podcast is less about the drugs, devices and procedures that can be administered and more about the habits, behaviours and philosophies that can help intensive care clinicians to master the craft of intensive care.