19 - Alex Psirides - Doing everything at the end of life (DasSMACC special episode)

Are you receiving elderly intubated patients where someone else says they want "everything" done? Are the doctors who refer patients to intensive care finding out what their patients really want towards the end of life? Does this frustrate you on a daily basis?

This is a huge topic in intensive care. Finding out the wishes of our patients before they end up on a ventilator with no one to speak for them is vital if we wish to deliver optimal healthcare. Yet so often we intensivists are left to deal with this situation. And whilst in most cases we do this very well, many of us like Dr Alex Psirides, a UK, New Zealand and Australian-trained intensivist, feel the despair as we hold another lengthy meeting with a patient's family. In this episode I spoke with Alex about this topic, which he had just delivered a brilliant TED-like talk on at the DasSMACC international conference in June. Alex has a great perspective to share as two of his specific clinical interests are managing dying patients and rapid response systems for deteriorating patients.

This is the fourth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Alex is an Intensive Care specialist at Wellington Regional Hospital in Wellington, New Zealand. His work and research in the area of rapid response systems has led to an appointment as the clinical lead for the New Zealand Health Quality & Safety Commission's 5-year national 'Deteriorating Patient' programme. He is also the clinical lead for Wellington's aeromedical retrieval service, which covers the lower North and upper South Islands of New Zealand. In his spare time, when not walking his dog or children, he builds websites & designs logos for Wellington ICU's prodigious research department, as well as sending a few tweets via Twitter handle @psirides.

Given Alex has been an ICU consultant for less time than most of my other guests, I had to talk him into doing an interview, but I'm really glad he agreed. There is so much to like about this conversation. Alex is honest and humble enough to say he's not so sure he's that good at predicting patient outcomes, at least in neurosurgical patients, which is the precise reason he has something to teach us on the podcast. We also cover topics including:

• Why Alex loves intensive care (with a great answer)
• How his consultant team work so cohesively
• The need to respect co-worker's opinions and to avoid tribalism
• How a team of intensivists meeting with a team of neurosurgeons away from the patients can make practice more consistent and evidence-based
• How his team uses simulation to reduce rudeness and lack of respect
• How efficiently his hospital ran when there was a 3 day doctors strike
• A good ward round requires asking for and addressing the nurse's concerns but also finishes with a clear plan to move the patient forwards
• Bringing his best self to work requires feeling loved at home and having a great team to work with
• Some of the non-textbook medical books Alex has been enjoying reading
• Hobbies allow him to escape from work and to use his creativity
• How far away he feels right now from burnout
• What he can get better at over the next 5 years
• How palliative care physicians can be helpful in teaching us and our trainees about end of life discussions

This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues or posting on social media.

Feel free to leave a comment or a question. I hope we can build community through Mastering Intensive Care so colleagues can share their thoughts and tell us how they are mastering their own skills. Leave a comment on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at andrew@masteringintensivecare.com.

Thanks for listening. Please do the very best you can for your patients.

Andrew Davies

Show notes (people, organisations, resources or links mentioned in the episode):

Wellington Intensive Care medical team: http://www.wellingtonicu.com/AboutUs/Staff/SMO/

DasSMACC: www.smacc.net.au

Alex Psirides talk on "Doing everything at end of life": http://wellingtonicu.com/Data/Doing%20Everything%20DasSMACC.pdf

Book "Being Mortal" by Atul Gawande: http://atulgawande.com/book/being-mortal/

Book "Do No Harm" by Henry Marsh: https://henrymarshdonoharm.wordpress.com/reviews/

Alex Psirides on Twitter: @psirides