13 - Sara Gray - Voices in my head (DasSMACC special episode)

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 perform better in other areas of life. But it's not easy to change these voices in our heads. And we need to slowly begin to develop the ability to simply observe them before we can do the more difficult work of making the voices kinder.

This is the first of a series of DasSMACC special episodes, where I interview speakers from the recent DasSMACC conference held in Berlin. This was the third SMACC conference I have attended, and I enjoyed it for its international and multi-disciplinary flavour, as well as the excellent speakers and the exceptional program including topics from resuscitation and critical care interventions to communication and our own health and well-being.

Dr Sara Gray is cross-trained in Emergency Medicine and Critical Care. She works in both areas at St. Michael's Hospital in Toronto, Canada, and is an Associate Professor at the University of Toronto. She is also the Medical Director for Emergency Preparedness at St Mike's. Her academic interests include knowledge translation and optimizing performance; specifically how to improve the care of critically ill patients in the Emergency Department. Her most important achievements are her kids, who don't care what she does at work all day, and who remind her of what really matters in life.

Sara spoke in the opening plenary session with a talk entitled "Voices in my head". In this podcast interview, we discuss the premise of her talk, which is mainly about developing self-compassion by noticing our inner voice. We speak about some resources Sara has used to develop her own self-compassion, including the use of mindfulness meditation, which she now regularly practices. Sara is insightful, thoughtful, a true leader, a caring doctor, and above all a woman blazing a path to helping us to look after ourselves, our work colleagues, and indeed our patients. She is really helping to modernize the thinking in intensive care and emergency medicine circles. We covered several other topics including:

• Sara's own career combining emergency medicine and intensive care
• The potential benefits to the organisation of having doctors trained in both specialties
• How intensivists can develop better relationships with their emergency department colleagues
• The potential benefit of teaching our children to meditate so that it becomes a normal part of an adult's life
• Sara's attitude to sleep, how she is not a good napper, and how she benefits from getting an even number of hours sleep
• How getting away by herself to read a book for just 30 minutes twice a week can revitalise her
• How doctors need to listen more and talk less – and some techniques to do that better
• How the ICU ward round in the St Michael's Hospital is structured
• Some of the phrases she uses when talking with colleagues and patient's families
• How being a patient in her own hospital reminds her to approach patients with what may seem minor complaints in a more engaged manner
• How burnout is not a binary outcome, and more something that she swings closer to or further from depending on the circumstances

With this podcast, and the previous episodes, please help me in 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. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media (using #DasSMACC, #SMACC or #FOAMed)

If you want to send a comment or respond to something Sara said on this episode, feel free to email me andrew@masteringintensivecare.com, leave a comment on the Mastering Intensive Care podcast page on LITFL or on Facebook, or post on twitter using #masteringintensivecare. I'd love to hear what you think are your major take-aways.

Thanks so much for listening. Please give your patients the very best care you can, and take care of yourself too.

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

Dr Kristin Neff's website: www.selfcompassion.org

MBSR course: Mindfulness-based stress reduction

Jon Kabat-Zinn: Founder of MBSR program

Headspace meditation: www.headspace.com

Sara Gray's previous SMACC talk on "Optimising critical care in the emergency department": https://itunes.apple.com/au/podcast/optimising-critical-care-in-emergency-department-by/id648203376?i=1000359000551&mt=2

Scott Weingart's SMACC talk on "Kettlebells for the Brain": https://itunes.apple.com/au/podcast/kettlebells-for-the-brain/id648203376?i=1000375455720&mt=2

DasSMACC website: www.smacc.net.au

Dr Sara Gray: https://saragray.org/