The St.Emlyn’s Podcast

Simon and Nat talk about how to have that tricky conversation when you have to tell a colleague that they may have made a mistake. vb S

Mastering the Art of Clinical Referrals: A Guide for Emergency Physicians Introduction Effective communication is crucial in the emergency department (ED), particularly when referring patients to inpatient teams. It not only ensures optimal patient care but also enhances professional relationships and personal job satisfaction. In this post, inspired by the St. Emlyns podcast, we'll explore a practical framework for making clinical referrals, emphasizing the importance of clear, structured communication. We'll discuss the SBAR (Situation, Background, Assessment, Recommendation) format, the concept of the "James Bond opening," and strategies for handling difficult conversations, all tailored to the fast-paced environment of emergency medicine. Why Effective Referrals Matter Referrals are an integral part of patient management in the ED. Every referral is made with the patient's best interest in mind, whether they need further investigations, specialized treatment, or simply continuity of care. Ensuring that the receiving team understands the urgency and context of the referral is vital. Good communication can influence how the inpatient team perceives the referring physician and can enhance collaborative relationships, leading to better patient outcomes and professional fulfillment. Setting the Stage: The James Bond Opening When initiating a referral, it’s essential to grab the attention of the receiving team quickly and effectively. This is where the "James Bond opening" comes in—start with a high-impact statement that summarizes the critical aspect of the patient's condition. For example, instead of saying, "I have a patient with abdominal pain," begin with, "I have a 25-year-old male who likely has appendicitis." This approach not only captures attention but also sets the stage for a focused and efficient conversation. The SBAR Framework: Structuring Your Referral The SBAR model provides a structured approach to communication, ensuring all essential information is conveyed succinctly. Here’s how to implement it: Situation Begin with a brief description of the patient's current condition. This is where the "James Bond opening" fits perfectly. Clearly state the key clinical concern that necessitates the referral. Background Provide context for the situation. This includes relevant medical history, the reason for the current ED visit, and any pertinent findings. For instance, you might say, "The patient has had two days of right iliac fossa pain and a history suggestive of appendicitis." Assessment Share your clinical judgment about the patient's condition. This not only demonstrates your understanding but also signals the expected pathway of care. In our example, "Based on the examination and symptoms, I believe the patient has appendicitis." Recommendation Conclude with a clear, direct request. Specify what you need from the inpatient team, such as a physical assessment, further diagnostic testing, or specific interventions. For instance, "I'd appreciate it if the surgical team could evaluate the patient for potential appendicitis and consider admission for further management." Enhancing the Referral Process: Tips and Tricks Introduce Yourself Clearly Always start the conversation by introducing yourself with your name and role. For example, "Hi, I'm Ian, one of the ED doctors." This personal touch helps build rapport and sets a friendly tone. If the receiving team introduces themselves by title only, politely ask for their name, fostering a more personable interaction. Predict and Prepare for Questions Anticipate the questions the receiving team might ask and prepare your responses. For example, if referring a potential appendicitis case, be ready to discuss symptoms, lab results, and physical findings. This not only streamlines the conversation but also demonstrates your preparedness and competence. Use the Illusion of Choice To smooth the referral process, offer options that guide the receiving team towards a decision that benefits the patient. For instance, "Would you prefer to see the patient in the ED or on the ward?" This technique, known as the illusion of choice, empowers the receiver while subtly directing the conversation towards the desired outcome. Navigating Difficult Conversations Not all referral conversations go smoothly. Sometimes, the receiving team may be uncooperative or dismissive. Here are strategies to handle such situations: Stay Calm and Professional If the conversation becomes contentious, avoid escalating the situation. Remain calm and professional, focusing on patient care rather than engaging in arguments. A useful tactic is to suggest pausing the conversation: "Let me discuss this further with my senior and get back to you." Seek Support from Senior Staff If you encounter resistance, consult a senior colleague or consultant. They can provide additional insights or take over the conversation, ensuring the patient receives the necessary care. Empathize with the Receiving Team Understand that the receiving team might be under significant pressure, dealing with their own caseloads and challenges. Acknowledging their situation can defuse tension and facilitate a more constructive dialogue. Conclusion: Practice Makes Perfect Effective referrals are a skill that, like any other medical procedure, requires practice and reflection. Using the SBAR framework, starting with a strong "James Bond opening," and preparing for potential questions can significantly improve the quality of your referrals. Remember, every interaction is an opportunity to enhance patient care and build professional relationships. For more insights and discussions on emergency medicine, communication skills, and more, visit the St. Emlyns blog and podcast series. Let's continue to improve our skills and ensure the best outcomes for our patients.

Communicating Difficult News in Emergency Medicine: A Guide from St Emlyns Introduction Effective communication of difficult news is a critical skill in emergency medicine. This guide, based on a discussion between Iain Beardsell and Liz Crowe, explores best practices for delivering challenging information to patients and their families, emphasizing compassion and clarity. The Importance of Language The terminology used when delivering bad news can significantly impact the recipient's perception. Liz Crowe suggests avoiding phrases like "delivering bad news" or "breaking bad news," as they imply a one-time transaction. Instead, "communicating difficult news" emphasizes an ongoing process that includes listening, support, and engagement. This language shift helps set a compassionate tone and encourages continuous dialogue, reassuring families that they are not alone. Building a Supportive Relationship The goal of communicating difficult news is not just to convey information but to build a supportive relationship. Unlike a delivery person who leaves after a transaction, healthcare professionals should remain engaged, ensuring that families feel heard and supported. This involves being present, offering a listening ear, and providing continuous support, which helps families process the news and feel significant during a difficult time. Self-Awareness in Communication Healthcare professionals must be self-aware of their emotions and biases when delivering difficult news. Liz points out that under stress, professionals might default to using medical jargon, which can distance them from the family. Recognizing one's emotional triggers and managing them is crucial for maintaining a compassionate demeanor. Self-awareness also involves understanding personal limitations and seeking support when needed, ensuring that caregivers can provide the best possible support to families. Creating the Right Environment The environment where the news is delivered plays a crucial role. A private, quiet space where everyone can sit comfortably helps create a sense of safety and respect. Healthcare professionals should take a moment to prepare mentally before the conversation, organizing their thoughts and emotions. This preparation helps in delivering the news clearly and calmly, reducing the chances of miscommunication. Nonverbal Communication and Setting the Tone Nonverbal cues, such as facial expressions and body language, significantly influence the tone of the conversation. Professionals should approach with a serious and empathetic demeanor, setting the expectation for a difficult conversation. A somber expression can help prepare families for the news, as opposed to a smile, which might create false hope. The first and last things said are particularly memorable, so they should be chosen carefully to ensure clarity and compassion. Clarity and Honesty Clarity is paramount when delivering difficult news. If a patient has died, it is essential to state this clearly and directly, avoiding euphemisms and medical jargon. Information should be given in small, digestible pieces, allowing families to process it. Professionals should also be prepared to repeat or clarify information, as initial shock can make it difficult for families to absorb all details. Handling Emotional Reactions Emotional reactions are natural and expected. Liz advises against immediately offering tissues, as this can imply discomfort with the family's grief. Instead, give them space to express their emotions. Healthcare professionals should be prepared for a range of responses, from tears to anger, and maintain a supportive presence throughout. Validating the family's emotions is crucial, as is allowing them time to grieve. Continuous Engagement and Follow-Up The conversation should not end after delivering the news. Continuous engagement is vital, including checking in with the family periodically and being available for follow-up questions. This ongoing support helps families feel cared for and reassures them that they are not left to navigate the situation alone. Follow-ups can include arranging further meetings, providing written materials, or referring to counseling services. Special Considerations for Children When children are involved, the information should be age-appropriate and delivered with care. Liz suggests involving children in the conversation, as excluding them can lead to confusion and mistrust. It is essential to use simple, clear language and to be honest about the situation. Reassuring children that it is okay to feel sad or confused helps them process their emotions. Respecting Cultural and Religious Beliefs Cultural and religious beliefs can significantly influence how families perceive and process difficult news. Healthcare professionals should respect these beliefs and tailor their communication accordingly. This might involve understanding specific rituals or customs and involving spiritual advisors when appropriate. Respecting these practices provides comfort and shows respect for the family's values. Conclusion Communicating difficult news is a challenging but essential aspect of emergency medicine. It requires empathy, clarity, and a commitment to ongoing support. By focusing on these elements, healthcare professionals can help families feel supported and understood during some of the most challenging moments of their lives. The insights shared by Liz Crowe and Iain Beardsell emphasize the importance of a compassionate and structured approach, ensuring that these conversations are handled with the utmost care and respect. For more insights on navigating complex topics in healthcare, stay tuned to the St Emlyns blog. We are committed to providing valuable information to support healthcare professionals in their journey of delivering compassionate and effective care.

Iain and Simon discuss the core skills that all EM clinicians need to manage pain in the ED. These are the basics, but don't be put off. The basics are more important than the fancy stuff that we will discuss in a later podcast. vb S

A podcast mini to round up and look forward to the next few months on the podcast. We also have a special recording of Danny Boy from the Irish Youth Choir and conducted by Greg Beardsell. This performance was dedicated to Dr John Hinds in Dublin following his untimely death in a motorcycle accident. Please listen and take a moment to remember him and all that he has done to inspire everyone involved in the care of the injured. vb S

Day 2 and 3 at #smaccUS. Iain and Simon round up the highlights and look forward to #smaccDUB. S

Navigating Grief: Lessons from the St Emlyns Podcast with Liz Crow In a compelling episode of the St Emlyns podcast, host Ian Bidsel engages in a profound discussion with pediatric social worker Liz Crow about the intricacies of grief, especially within the healthcare sector. This episode was prompted by the tragic loss of John Hines, a respected member of the SMACC community known for his work as a motorcycle doctor. Liz shares her insights into the unique challenges faced by healthcare professionals when dealing with grief, both personally and professionally. The Unique Nature of Grief Grief is a deeply personal experience that varies significantly from person to person. Liz Crow emphasizes that there is no "normal" way to grieve; each individual's response is shaped by various factors, including age, personality, and prior experiences with loss. The podcast challenges the traditional Kubler-Ross model, which suggests a linear progression through five stages of grief. Liz argues that grief is a fluid process without a set path, characterized by an unpredictable mix of emotions. Grieving in the Healthcare Profession Healthcare professionals often encounter death and suffering, which can complicate their grieving process. The sudden death of John Hines highlighted the vulnerabilities even within a community accustomed to dealing with trauma. Liz and Ian discuss the common practice of compartmentalization among healthcare workers, where emotions are set aside to focus on the task at hand. While this can be a necessary coping mechanism, Liz warns against prolonged avoidance of emotions, as it can lead to long-term psychological issues. The conversation underscores the importance of self-awareness and self-care. Healthcare professionals are encouraged to acknowledge their grief and seek support when necessary. This may involve adjusting work responsibilities or taking time off to process emotions. Liz stresses that compartmentalization should be temporary and that healthcare workers need to find safe spaces to express and process their grief. Coping Strategies and Community Support Liz explores various coping strategies that can help individuals navigate their grief. These include journaling, physical activity, creative expression, and talking with trusted friends or professionals. The key is to find what works best for each person. The SMACC and FOAMed communities provide a supportive network, especially through social media, which has facilitated shared experiences and mutual support. However, Liz notes that online interactions can sometimes lack the depth needed for processing complex emotions. The podcast also addresses the public aspect of grieving, particularly when the person lost is a public figure like John Hines. For those who admired him, his death serves as a stark reminder of life's fragility. Liz and Ian discuss the discomfort of confronting mortality, especially when it involves someone perceived as larger than life. This public grieving can add another layer of complexity to personal mourning. The Importance of Open Conversations About Grief A significant theme in the podcast is the need for open dialogue about grief. Liz encourages listeners to communicate their feelings and to be open about their vulnerabilities. She highlights the cultural stigma against showing emotion, particularly among men, and calls for a shift in how we perceive emotional expression. The healthcare community, often valuing emotional resilience, may need to rethink its attitudes toward vulnerability. Ian shares his personal experiences of feeling isolated in his grief, particularly in professional settings where the expectation is to maintain a façade of normalcy. Liz acknowledges this common experience and emphasizes the importance of finding supportive communities and being open about one's struggles. Integrating Grief into Life Liz suggests that instead of viewing grief as something to "move through," it should be seen as an experience to integrate into one's life. She uses the metaphor of grief as a wound that eventually becomes a scar—while the initial pain may subside, the impact of the loss remains. This perspective encourages compassion for oneself and others, recognizing that grief is an ongoing process rather than a problem to be solved. For those struggling to cope, Liz recommends seeking professional help, particularly if grief begins to manifest as clinical depression. She distinguishes between the natural process of grief and the symptoms of depression, advising individuals to seek support if they find themselves unable to manage their emotions. The Role of Professional Support and Self-Care The podcast highlights the critical role of professional support and self-care for healthcare workers. Liz discusses the importance of accessing supervision and counseling, especially during personal crises. Self-care is not a luxury but a necessity, particularly for those in caregiving roles who may prioritize others' needs over their own. This can include taking time off, engaging in hobbies, or simply allowing oneself to grieve. Moving Forward with the Community As the SMACC and FOAMed communities continue to process John Hines' loss, this podcast serves as a reminder of the collective nature of grief and the importance of community support. The conversation provides valuable insights into the complexities of grieving, the significance of open dialogue, and the power of mutual support. In conclusion, Liz and Ian emphasize that grief is a natural part of life, much like happiness. They encourage listeners to approach their grief with gentleness and understanding, acknowledging that there is no right or wrong way to grieve. Whether through professional support, personal coping strategies, or community connections, the journey through grief is unique to each individual. The key takeaway is to be patient with oneself and others, recognizing that healing is a gradual and ongoing process. This episode of the St Emlyns podcast offers a deep exploration of grief, providing practical advice and emotional support for those navigating this challenging experience. The conversation encourages healthcare professionals and the wider community to engage openly with their emotions and to support one another through the journey of grief.

The first day of #smacc15 was amazing. An incredible introduction and an amazing program. Have a listen to what the St.Emlyn's team got up to on day one. S

In this episode of the St Emlyn's podcast, Simon Carley and Iain Beardsell share insights from the SMACC 2015 conference in Chicago, focusing on the holistic experience of being a clinician. Ian delves into a personal and poignant case involving a 14-year-old boy named Charlie, who tragically died from traumatic injuries. Ian discusses the profound emotional impact this case had on him, the lingering doubts it created, and how it influenced his professional and personal life. This episode highlights the emotional challenges faced by emergency medicine practitioners and underscores the importance of mental resilience, compassionate communication, and self-care. 00:00 Introduction and Conference Overview 00:43 Session on Being Human and a Doctor 01:26 Iain's Personal Journey and Case Introduction 02:29 The Case of Charlie: A Traumatic Experience 05:43 Emotional Impact and Professional Reflection 09:24 Dealing with Doubt and Seeking Closure 11:53 Lessons Learned and Advice for Colleagues 17:20 Final Thoughts and Encouragement

SMACC Chicago: Insights, Learning, and Community at St Emlyn's The SMACC (Social Media and Critical Care) Conference in Chicago brought together healthcare professionals and thought leaders from around the world. The St Emlyn's team, comprising Iain Beardsell, Simon Carley, Rick Boddy, and Natalie May, participated in various workshops and sessions, sharing their experiences and insights. This blog post captures the essence of the conference, highlighting key learning outcomes and the vibrant community spirit. Evidence-Based Medicine: From Theory to Practice Simon Carley kicked off the day with a workshop titled "Gambling with the Evidence," focusing on practical applications of evidence-based medicine (EBM). Unlike traditional EBM sessions that often dwell on statistics and literature reviews, this workshop emphasized how to translate evidence into clinical practice. Simon, alongside Rick Boddy, Rob McSweeney, Ken Milne, and Rory Spiegel, explored how healthcare professionals manage the overwhelming volume of evidence and integrate it into their practice. Key takeaways included strategies for storing and accessing evidence efficiently, influencing colleagues with evidence-based practices, and the importance of critical skepticism. The workshop stressed the responsibility of individuals to thoroughly understand the evidence before implementing changes in clinical settings. This session underscored the necessity of a balanced approach to adopting new practices, ensuring they are rooted in a comprehensive understanding of available evidence. FOAM: Creating and Sharing Educational Content Natalie May joined other prominent figures in the FOAM (Free Open Access Meducation) community for the "Brew Your Own FOAM" session. Alongside Salim Rezé, Rob Rogers, Haney Malamarts, and others, Natalie discussed the creation of blogs, podcasts, and other educational resources. The session, likened to an Apple bar, provided an informal yet informative platform for attendees to engage with experienced content creators. Participants gained insights into the technical and creative aspects of producing FOAM content. The session encouraged the sharing of knowledge and resources, emphasizing that a diverse range of voices and perspectives enriches the medical community. Natalie highlighted the importance of FOAM in democratizing medical education, making high-quality information accessible to a global audience. Exploring Chest Pain and Cardiology Pathways Rick Boddy delved into the nuances of chest pain management and cardiology in his workshops. The morning session on evidence-based medicine included discussions on the values and outcomes in clinical trials, particularly concerning stroke and thrombolysis. Rick emphasized the varying perspectives of patients, doctors, and policymakers, stressing the importance of considering these viewpoints when evaluating clinical outcomes. The afternoon's emergency cardiology workshop, featuring experts like Steve Smith and Louise Cullen, focused on chest pain pathways. The session covered a range of topics, from ECG interpretation to chest pain algorithms. Rick noted the growing interest in high-sensitivity troponins and the need for tailored chest pain pathways that cater to specific local populations. The discussion also addressed the challenges of implementing standardized pathways and the importance of trusting the evidence. Getting Creative: Enhancing Communication Skills Simon Carley also participated in a workshop titled "Getting Creative," which explored creative communication methods in the medical field. The workshop featured three sessions: Michelle Johnson on writing, Grace Slyo on visual presentations, and Rob Rogers on podcasting. Michelle Johnson, a skilled writer, guided participants through the art of crafting compelling narratives, particularly for blog posts. She emphasized the power of language and the importance of clear, concise communication. Grace Slyo's session focused on improving visual communication, offering tips on graphic design and effective presentation techniques. She provided valuable resources and exercises to help participants enhance their visual storytelling skills. Rob Rogers concluded the workshop with practical advice on creating engaging podcasts, covering everything from content creation to technical aspects. Simon found the workshop incredibly valuable, noting that these skills are essential for effective knowledge dissemination in the medical community. Pediatric Critical Care: Lessons and Strategies Natalie May attended the SMACC mini session on pediatric critical care, where experts discussed managing critically ill children in emergency and intensive care settings. The session opened with Fran Lockey and Phil Hyde addressing pediatric airway and breathing management. They emphasized the importance of simple airway maneuvers and two-handed bag-valve-mask ventilation, debunking the myth that intubation is always necessary. Lisa McQueen provided a poignant presentation on children in shock, referencing the case of Rory Staunton, a child who tragically died from sepsis after being discharged from the emergency department. The session highlighted the critical role of thorough reassessment and face-to-face evaluations in pediatric care. The importance of vigilance in monitoring children's progress before discharge was a key message. Pre-Hospital Care: Excellence in Action Iain Beardsell shared his experience from the pre-hospital care workshop, led by Carol Harbig from Greater Sydney Hems. The workshop featured a range of topics and speakers, providing an in-depth look at pre-hospital emergency medicine. The highlight of the day was a presentation by Ashley Leibig, who delivered a powerful talk on the emotional challenges faced by pre-hospital care providers and the importance of peer support. Iain emphasized the value of visualization and mental rehearsal in preparing for high-stress situations. The workshop underscored the importance of practicing difficult scenarios mentally to ensure readiness when faced with real-life emergencies. This approach helps clinicians develop a clear action plan, reducing the likelihood of hesitation or error during critical moments. The SMACC Community: Beyond Clinical Knowledge One of the standout features of the SMACC Conference is its holistic approach to medical education. The conference not only covers clinical and technical topics but also addresses the emotional and psychological aspects of healthcare. Ashley Leibig's talk, reminiscent of Liz Crowe's impactful presentations, reminded attendees of the need for compassion and self-care in a field often dominated by high-stakes decision-making. The conference provided ample opportunities for networking and community building. The St Emlyn's team noted the importance of connecting with peers, sharing experiences, and learning from each other. The collaborative spirit of the FOAM community was palpable, with participants eager to exchange ideas and support one another in their educational endeavors. Preparing for the Big Stage: Final Thoughts As the day drew to a close, the St Emlyn's team prepared for their presentations at the conference. The anticipation and nerves were palpable, reflecting the high regard in which the opportunity to speak at SMACC is held. The team emphasized the importance of thorough preparation, including practicing presentations and ensuring all details are in order. The St Emlyn's team encouraged attendees and followers to engage with them, highlighting the value of these interactions in enriching the conference experience. They looked forward to meeting new people and deepening connections within the medical community. Conclusion The SMACC Conference in Chicago provided a rich and varied learning experience for the St Emlyn's team. From evidence-based medicine to pediatric critical care and pre-hospital medicine, the workshops offered valuable insights and practical knowledge. The conference also underscored the importance of creative communication, emotional resilience, and community support in the medical field. For those unable to attend, the St Emlyn's team hopes this blog post offers a glimpse into the vibrant and dynamic environment of SMACC. The team is committed to sharing the knowledge and experiences gained at the conference, contributing to the broader medical community's growth and development. As always, the St Emlyn's team encourages feedback and engagement from their readers. Whether you're interested in evidence-based medicine, FOAM, pediatric care, or any other topic, there's something for everyone in the rich tapestry of SMACC. Stay tuned for more updates and insights as the conference continues to unfold.