Mastering Intensive Care

Our ICUs might be growing larger in size but there seem to be the same number of very sick patients to care for overall. All of which means we seem to be admitting a greater proportion of less unwell patients to our ICUs, especially in the larger tertiary ICUs. Given we also suffer from "bed block", where there are no available beds in the hospital to transfer patients to, when they are no longer critically ill, our ICUs can become holding bays for effectively "ward-level" patients. This may be great for the patients but it means longer ward rounds, and a level of frustration for intensive care teams, who may feel like they are not making a significant enough difference for these less sick patients. When A/Prof Michael O'Leary started out in Intensive Care nearly 30 years ago, he remembers being enthusiastic and busy, performing many interventions on mostly sick patients. Having now moved across the world and gained a few decades of experience, he has a great perspective on some of the challenges our larger ICUs face. Michael is former President of the Australian & New Zealand Intensive Care Society and a Senior Specialist in Intensive Care in Sydney, working at Royal Prince Alfred Hospital and St George Private Hospital. He is Clinical Associate Professor at Sydney Medical School, The University of Sydney, and Co-State Medical Director of the New South Wales Organ and Tissue Donation Service. Michael trained in anaesthesia in the United Kingdom and holds a Fellowship of the Royal College of Anaesthetists (FRCA). His intensive care training commenced in the UK in Cambridge and continued in Sydney where he achieved Fellowship of the College of Intensive Care Medicine of Australia and New Zealand (FCICM). Michael was a Research Fellow at St Bartholomew's Hospital, London, UK where he completed his MD degree with studies into the metabolic response to sepsis and use of glutamine and growth hormone in the amelioration of catabolism. In recent years his main interests have been in end-of-life care and organ donation in the ICU. This episode was conducted in May 2018 as a live interview in front of a conference audience at the 5th SG-ANZICS Asia Pacific Intensive Care Forum. Thanks to that meeting's Organising Committee, representing Singapore's Society of Intensive Care Medicine (SICM), Singapore, and the Australian and New Zealand Intensive Care Society (ANZICS), I was invited to conduct several such live interviews for this podcast. Many thanks to Tan Hon Liang and David Ku for this opportunity. Apart from his observations about the growth and change in Intensive Care over the last few decades, Michael and I talked about: How the SG-ANZICS meeting came to be His career history Being a part-time intensivist Playing the role of Co-State Medical Director of an organ donation service The characteristics of good intensivists Being President of ANZICS and the importance of being involved with professional societies Some perspectives on good communication and clinical care. The Mastering Intensive Care podcast is aimed to inspire and empower intensive care clinicians to bring their best selves to the intensive care unit through conversations with thought-provoking guests. I genuinely believe we can help each other to improve, as both professionals and as people, so as to give the absolute best possible care to our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Andrew Davies -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Michael O'Leary on LinkedIn: https://www.linkedin.com/in/michael-o-leary-a1222b11/?originalSubdomain=au SG-ANZICS Asia Pacific Forum: http://sg-anzics.com/ Episode 36 with Hayley Gershengorn: http://masteringintensivecare.libsyn.com/episode-36-hayley-gershengorn-allocating-icu-resources-to-optimise-patient-outcomes-and-job-satisfaction Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care New Normal Project podcast: http://newnormalproject.libsyn.com/ Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

What number of patients should an intensivist simultaneously care for to optimise outcomes? Is a system with different day and night intensivists best for all? These are two of the questions discussed during the latest episode of Mastering Intensive Care in which Hayley Gershengorn shares her research and personal thoughts about resourcing our Intensive Care Units. There is no easy answer to matching supply and demand in our workforces, not least because it is very different between the different health professionals that work in the ICU. The current resources available and the average daily demands seem to be the key decision-making drivers in many institutions and we probably have a lot to learn from analysing big data in this area. Doctors could learn a lot from how nurses staff themselves, and likely vice versa. It is also vital that we find ways to delicately balance the needs of clinician wellness and job satisfaction with the obvious requirement for optimal patient outcomes. Turning up the screws on our staff by working them more often, in longer stretches and with an increasing number and acuity of patients, will inevitably increase burnout rates and lead to suboptimal patient outcomes. The more we can talk about this, and study it, as Hayley is doing, the better. Hayley is an Associate Professor of Pulmonary and Critical Care Medicine at the University of Miami, Miller School of Medicine. She received her medical degree from Harvard Medical School and completed a residency in Internal Medicine at New York Presbyterian Hospital-Cornell and a fellowship in Pulmonary and Critical Care Medicine at New York Presbyterian Hospital-Columbia. Hayley's research program focuses on the allocation of ICU resources and the impact such allocation has on the outcomes of critically ill patients. In particular, she is interested in understanding how (1) ICU staffing and (2) practices which may be tied to staffing, affect patient outcomes. In addition to ICU resourcing Hayley talked about: Her medical training background Her initial study of mathematics A "gap" year she took as a management consultant What gives her the most enjoyment in intensive care Her thoughts on her own institution's staffing model Why some people choose to be full-time nocturnal intensivists The concept of strain - on ICUs and on intensivists How we might better understand staff well-being The benefits to her of switching between clinical duties and research The advice her parents gave about achieving balance Her own lifestyle including exercise, movies, outdoor activities and sleep Bringing her best self to work often involves asking for help The benefits of having trainees always watching her Using group messaging service chats to attend to emotional needs The struggles of finding people to trust when moving institutions Thoughts on mentoring and coaching in intensive care medicine Her focus on human connection in communication Being open with families by answering personal questions Crediting her psychologist mother for helping her communicate The Mastering Intensive Care podcast is aimed to inspire and empower intensive care clinicians to bring their best self to the intensive care unit through conversations with such thought-provoking guests as Hayley Gershengorn. I genuinely believe we can help each other to improve, as both professionals and as people, so as to give the absolute best possible care to our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Andrew Davies -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Hayley Gershengorn profile: https://doctors.umiamihealth.org/provider/Hayley+Beth+Gershengorn/525503 Twitter handle for Hayley Gershengorn: @HBGMD UK-based study conducted by Hayley and colleagues: https://www.ncbi.nlm.nih.gov/pubmed/28118657 Episode 35 with Paul Wischmeyer: http://masteringintensivecare.libsyn.com/episode-35-paul-wischmeyer-never-underestimate-the-simple-things-we-do-to-our-patients Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care New Normal Project podcast: http://newnormalproject.libsyn.com/ Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

How did your patient feel that time you took several attempts to place a CVC? What might happen after a dose of haloperidol for delirium? In this compelling episode, Professor Paul Wischmeyer, shares some of his experiences as a patient in the ICU. Since he was 15 he has endured multiple hospitalizations and ICU stays for his inflammatory bowel disease. This has given him an excellent vantage point to notice what we as ICU professionals do and say to our patients. And from Paul's perspective we could do much better. Some of the procedures we might think are simple (like placing intravenous or intra-arterial cannulae) can cause significant suffering. And if we treat these procedures as something just to tick off on our list we may diminish the person-centred care we should all be attempting to deliver. Paul's passion for helping patients recover from illness and surgery arises from his personal experiences as both a doctor and patient in the ICU. As a trained intensivist, anaesthetist, clinical pharmacologist and research scientist, he works predominantly as a Perioperative physician who specializes in enhancing preparation and recovery from surgery and critical care at Duke University. He practices on the Critical Care and Nutrition clinical teams, serves as the Director of Perioperative Research for the Duke Clinical Research Institute, as Associate Vice Chair for Clinical Research in the Department of Anesthesiology and as Director of the Nutrition Support Team. Paul has been awarded significant amounts of funding, won many awards, published over 135 papers and given hundreds of invited presentations. Five days ago Paul tweeted he was back in hospital so I thought it was a good time to bring this interview we did a few months ago. I'm hoping he is much better today and that he'll be out of hospital and back home very soon. Paul has a lot of valuable things to say in this interview. We also spoke about: How in the early part of his career he loved the physiology and pharmacology but now he loves the family interactions and teaching Learning from people all around the world makes him a better doctor How his personal experiences have helped him to use more sedation in his practice Our need to get away from the concept of keeping a patient quiet with sedatives so we can have a peaceful night in the ICU The effects on his mother of a child psychiatrist asking her about her parenting in the work up of Paul's illness His reflections on the difference in ward rounds between his current and previous institutions His views on having a close partnership between intensivists and the palliative care team, especially in family meetings The importance of body position and body language in communication How he feels less healthy in a system of 12 hour shifts for intensivists because scheduling self-care can be difficult The anxiety he notices when he doesn't exercise His views on a good diet and the supplements he takes His need to feel ready to be hospitalised at any time due to his illness The benefit of having a good department chair who helps him say no to too many responsibilities How he deals with feeling overwhelmed The importance of staying well-hydrated during our work His main points about giving a great lecture, including the use of images and developing the skill of inspiring or convincing the audience with emotion Some tips for younger clinicians, including being open minded, keeping up with the literature and focusing on connection to patients My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Paul Wischmeyer. I genuinely believe we can all improve, as both professionals and as human beings, so that we can do the absolute best for the people we are privileged to care for as patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Andrew Davies -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Paul Wischmeyer profile: https://scholars.duke.edu/person/paul.wischmeyer Paul's webpage on Duke Clinical Research Institute website: https://dcri.org/our-work/therapeutic-expertise/perioperative-nutrition/ Twitter handle for Paul Wischmeyer: @Paul_Wischmeyer Book: "Presentation Zen Design" (by Garr Reynolds): http://www.presentationzen.com/presentationzen/2010/02/presentation-zen-design-the-book.html Book "In Shock" (by Dr Rana Awdish): https://www.ranaawdishmd.com/book TARGET study: https://clinicaltrials.gov/ct2/show/NCT02306746?term=TARGET+nutrition&type=Intr&cntry=AU&city=Adelaide&rank=1 Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

Do you have too many career interests outside of your basic clinical practice? Are your daily focus areas as few as three? Family, clinical and perhaps one other thing? In this episode Australian intensivist, Marianne Chapman, speaks about how she keeps her life under control by focussing on her big three - family, clinical and research. This allows her to manage the stresses of an intensive care career. She sometimes has to say no very deliberately, and although she finds this hard, it helps her manage the workload. She notices that some of her colleagues seem to want to be experts in several areas, and whilst this may be important at the beginning of our careers, this can be a recipe for disaster for some of us over the longer term. Marianne is a Senior Staff Specialist in Intensive Care Medicine at the Royal Adelaide Hospital and a Clinical Professor of Acute Care Medicine in the School of Medicine at the University of Adelaide, both in Adelaide, Australia. Her clinical research interests include gastrointestinal dysfunction underlying problems with the administration of enteral nutrition and the clinical effects of nutrition in the critically ill. Marianne is an eminent international researcher in this field and has published extensively on these topics. Marianne and I recorded our conversation a little while ago and it's great to be able to air it now. In the interview, Marianne spoke about: How she sees every clinical encounter as a teaching experience, and how she learns a lot from her senior trainees The feeling of being drained and tired from a busy day teaching at work How caring for the patient and their outcome, whilst improving our knowledge base, helps us become the best we can be What it is like to have moved into a new building at her hospital The benefits of doing multi-disciplinary and collaborative Grand Rounds What role she takes in urgent clinical encounters How deaths in her own family have made her realise that how we approach families can significantly influence grief How huge cost savings may eventuate if intensivists are well-trained in communication with families What words and phrases she uses in communication encounters The pros and cons of 7 day stretches for ICU consultants Why research helps her feel like she is doing better care for patients The difficulties of a research career – which brings a different form of stress to clinical work How she manages stress by remembering that family comes first The value she sees from physical exercise The difficulty associated with looking after colleagues we are worried about How she has balanced family and work over her career Her thoughts on the issues of gender in intensive care How she might manage the transition towards retirement Her concerns about some clinicians having a need to always do something – and that maybe less is better Becoming involved with clinical trials groups is a great way to start a research career My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Marianne Chapman. I genuinely believe we can all improve, as both professionals and as human beings, so that we can do the absolute best for the people we are privileged to care for as patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. If you wish to connect, leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Marianne is an erudite, thoughtful, patient and humble intensivist with an excellent approach to not becoming overloaded. Please enjoy listening to the podcast. Andrew Davies -------------------- Show notes (people, organisations, resources and links mentioned in the episode): ANZICS Clinical Trials Group: https://www.anzics.com.au/about-the-ctg/ TARGET study: https://clinicaltrials.gov/ct2/show/NCT02306746?term=TARGET+nutrition&type=Intr&cntry=AU&city=Adelaide&rank=1 Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

Do you spend time finding out what the "why" is for your patient? Have you considered it's not what is the matter with the patient but what matters to the patient? What the patient thinks their purpose is? Or at the very least, what they wish for during the next part of life, however short that may be? In this episode American intensivist, Dr Wes Ely, tells us how he deeply cares about the whole patient – the body, the mind and the spirit. He is passionate about really getting to know his patients. And to do that he thinks we need to be heavily focused on both ICU liberation and good listening. The ICU liberation bit sounds easy. It's removing the patient from the sedatives, the ventilator and whatever other harmful interventions are no longer needed when their situation is improving. But it's harder than we think. And to help with this, he has led the development of the ABCDEF bundle. With the assistance of many colleagues, and based on high quality science, he has progressively developed a simple 6 factor approach that has been shown to speed up ICU liberation and improve patient outcomes. And in this podcast he describes how he uses it, and how you can too. Listening to our patients also sounds easy. But how many of us spend the time required, and really be there for that person with grace and humility, so we can truly find out what matters to them, and respect their spiritual faith. Wes will be well known to many of you. He is a Pulmonary and Critical Care specialist who conducts patient-oriented, health services research as a Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University School of Medicine, in Tennessee, USA. He is also a practicing intensivist with a focus on Geriatric ICU Care, as the Associate Director for Research for the VA Tennessee Valley Geriatric Research and Education Clinical Center. His research has focused on improving the care and outcomes of critically ill patients with ICU-acquired brain disease. Wes has built the ICU Delirium and Cognitive Impairment Study Group and his team have developed the primary tool by which delirium and health-related quality of life outcomes are measured, the CAM-ICU. He has over 350 peer-reviewed publications and over 50 published book chapters and editorials. In this conversation, Wes and I cover many other topics including: How he chose medicine after observing family illness as he grew up The enjoyment he receives from holding the hands of and looking into the eyes of patients How good doctors are not distracted by technology A Wall St journal and a CNN.com article he has penned which display his ability to find out what really mattered to 2 of his patients The importance of reading - and the 3 types of reading we should do How his ICU ward round is patient-centric and heavily nurse-focused The need to understand our unconscious biases and to have humility The concept of becoming the best version of our selves That life balance requires exercise, sleep and healthy eating His passion for triathlons, including the ironman How he balances family and work How his spiritual faith helps him to minimize stress His understanding that there is something bigger than us happening around us How burnout is simply an imbalance in the fundamentals of life The Nietzsche quote "He who has a why to live can bear any how" His appreciation of the work of the 3 Wishes Project (links below) What happened when he read the Jabberwocky poem (link below) to one of his patients His advice that young clinicians should be patient and truthful What the mnemonic DR-DRE means to him My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Wes Ely. I passionately believe we can all get better, both as carers and as people, so we can do our absolute best for those patients whose lives are truly in our hands. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. If you wish to connect, leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Wes Ely is a genuine leader of our specialty and is a wise, philosophical and compassionate doctor with a refreshing spiritual perspective. Please enjoy listening to the podcast. Andrew Davies -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Wall St journal article about bringing a swimming pool to the ICU: https://www.wsj.com/articles/a-swimming-pool-in-the-icu-1466117000 This article was published in the medical literature too: https://link.springer.com/article/10.1007/s00134-016-4434-0 CNN.com article about patient Paul: https://edition.cnn.com/2018/03/20/opinions/caregiving-what-its-like-to-be-me-wes-ely-opinion/index.html The ABCDEF bundle: http://www.iculiberation.org/Bundles/Pages/default.aspx Lancet article on an RCT of no sedation: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62072-9/abstract New England Journal of Medicine article on RCT of daily interruption of sedative infusions: https://www.ncbi.nlm.nih.gov/pubmed/10816184 New England Journal of Medicine article on RCT of spontaneous breathing: https://www.ncbi.nlm.nih.gov/pubmed/8948561 Lancet article on Awakening and Breathing Controlled RCT: https://www.ncbi.nlm.nih.gov/pubmed/18191684 Lancet article on RCT of early physical and occupational therapy: https://www.ncbi.nlm.nih.gov/pubmed/19446324 Critical Care Medicine article about the ABCDEF bundle: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830123/ Critical Care Medicine article about a single-centre ABCDE bundle trial: https://www.ncbi.nlm.nih.gov/pubmed/24394627 Critical Care Medicine article about a multi-centre ABCDEF bundle trial: https://www.ncbi.nlm.nih.gov/pubmed/27861180 William Osler: https://en.wikipedia.org/wiki/William_Osler Dalai Lama: https://www.dalailama.com/ Matthew Kelly: http://www.matthewkelly.com/ Fulton Sheen: https://www.fultonsheen.com/ David Bennett: https://www.rushu.rush.edu/faculty/david-bennett-md The Merton prayer: https://reflections.yale.edu/article/seize-day-vocation-calling-work/merton-prayer Friedrich Nietzsche: https://en.wikipedia.org/wiki/Friedrich_Nietzsche Viktor Frankl: https://en.wikipedia.org/wiki/Viktor_Frankl Annals of Internal Medicine article on the 3 Wishes Project: https://www.ncbi.nlm.nih.gov/pubmed/26167721 Another article on the 3 Wishes Project: https://www.ncbi.nlm.nih.gov/pubmed/27525361 Poem "Jabberwocky" by Lewis Carroll: https://www.poets.org/poetsorg/poem/jabberwocky Mother Teresa: http://www.motherteresa.org/index.html Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

What is it like to witness an intensivist struggle? And what can we learn from the shocking death of an intensivist? This special Mastering Intensive Care episode is on a difficult and important topic. Rather than focusing on bringing our best selves to work, the focus of this episode is the ultimate tragedy of our profession, doctor suicide. I warn you that this is a sad and confronting story about the troubling situation intensivist Richard Harding went through, including dealing with a mental health condition as well as a medical complaint made against him, before ultimately taking his own life 8 months ago in New Zealand. Richard's death is still under investigation by the New Zealand Coroner and the findings as to the final cause and circumstances of his death have not been released. In this podcast, his wife, Kate Harding, describes her observations and perspectives on what happened to Richard. I didn't know Richard. I only came to know of his death when Kate wrote a blog piece in the British Medical Journal. It was sad and it was moving. When she published another article in the Guardian two months later, I figured that whilst Kate was grieving as she dealt with the aftermath of a serious life crisis, she wanted to tell her story to help others. Kate grew up in Brussels, went to medical school in Glasgow, and has worked all over the UK as well as in Australia and in New Zealand. She is primarily a hospice doctor, but also works part-time as a GP. Kate also enjoys writing and her engrossing articles are linked below. Richard and Kate emigrated to New Zealand with their teenage children in 2016 but after his untimely death in October 2017, Kate and her children have returned to the UK. She has a strong interest in mental health, as well as in doctors' wellbeing, with a particular focus on the General Medical Council complaints procedure. Kate tells us that Richard's depression and subsequent death were in large part triggered by the stress of going through his first ever GMC complaint, despite being completely exonerated from any wrongdoing. Kate and her children are adjusting to their new life back in Britain, while missing Richard desperately, as well as their community in Whangarei, NZ. Kate has started running, tries to attend her Buddhist group every week, drinks far too much coffee, and lavishes unhealthy amounts of love on her long-suffering cavalier, Mo. Mainly, though, she worries about her children. Work helps to ground her, as does the mountain of financial, legal and general paperwork that now rules her life. The main purpose of this interview is to help Kate in advancing the conversation about suicide, about mental health, about dealing with medical complaints and to discuss the simple fact that our jobs and lives as intensive care professionals are arduous. When our colleagues die in these circumstances we must reflect on what this means for us as a specialty. We need to reduce the stresses and pressures we all feel in our work and our lives and we need to ask each other if we are OK. Please help me to spread the message by simply emailing your colleagues, or posting on social media. You can leave a question or comment on the Facebook "mastering intensive care" page, on the Life In The Fast Lane episode page, on twitter using #masteringintensivecare and @andrewdavies66, or by sending me an email at andrew@masteringintensivecare.com. On this topic there are no easy solutions. Doctors have a significantly higher suicide rate than the general population. Whilst all situations are unique and individual, there seems so much we can learn to prevent our colleagues and our friends from going through what Kate is. It is a privilege to bring you my conversation with Dr Kate Harding. Andrew Davies If you feel you need help, please call your national 24 hour hour crisis counseling service. In Australia go to www.lifeline.org.au or www. beyondblue.org.au. -------------------- Show notes (people, organisations, resources or links mentioned in the episode): Lifeline: www.lifeline.org.au Beyond Blue: www.beyondblue.org.au Blog piece in British Medical Journal written by Kate Harding: https://blogs.bmj.com/bmj/2017/12/14/kate-harding-i-have-lost-my-husband-could-not-be-more-accurate-it-feels-like-a-carelessness/ Article in The Guardian written by Kate Harding: https://www.theguardian.com/lifeandstyle/2018/feb/24/went-walk-returned-husband-suicide-depression General Medical Council: https://www.gmc-uk.org/ Kate Harding on Twitter: @KateJH1970 Other articles written by Dr Kate Harding: https://www.doctorportal.com.au/mjainsight/2018/18/doctors-wellbeing-learning-from-richards-death/ http://www.pulsetoday.co.uk/views/blogs/adjusting-to-widowhood-and-gp-life-back-in-the-uk/20036549.article http://www.pulsetoday.co.uk/views/blogs/dr-kate-harding/finding-solace-in-ae/20036708.article http://www.pulsetoday.co.uk/views/blogs/dr-kate-harding/an-exercise-in-patience/20036872.article Book "Why We Sleep: The New Science of Sleep and Dreams" (Matthew Walker): https://www.amazon.com.au/Why-We-Sleep-Science-Dreams/dp/0241269067 Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

Is your ward round stimulating and educational? Do you help learning by creating debates on the ward round for and against the simple interventions we use? In this week's episode, Belgian intensivist, Professor Jean-Louis Vincent describes what happens in his ICU, on a daily basis, and indeed on the ward rounds. He tells us how he enjoys going several times a day to see what is happening in his ICU, the schedule of ward rounds there, the importance of a single conversation on the ward round, and how much we can learn from our patients, especially about their physiology. Jean-Louis is perhaps the most well-known intensivist in the world. He is a major leader of his generation and in fact a pioneer of the large international conference, having run the Brussels International Symposium of Intensive Care and Emergency Medicine (ISICEM) for a staggering 38 consecutive years. Jean-Louis is a Professor of Intensive Care Medicine at the University of Brussels and an intensivist in the Department of Intensive Care at Erasme University Hospital in Brussels. He is a Past-President of the World Federation of Societies of Intensive and Critical Care Medicine, the European Society of Intensive Care Medicine, the European Shock Society, the Belgian Society of Intensive Care Medicine and the International Sepsis Forum. Jean-Louis has published over 900 original articles, over 400 book chapters and review articles and has edited 102 books. He is the editor-in-chief of Critical Care, Current Opinion in Critical Care, and ICU Management & Practice and he is a member of the editorial boards of about 30 other journals. In this conversation, Jean-Louis and I also covered topics such as: Why the speed of change with patients is what he loves the most His enjoyment of a combination of clinical, research and education Mentoring trainees starts by having them present their organized thoughts about each patient's problems and their management plans How his ICU uses the SOAP approach (subjective, objective, assessment, plan) on ward rounds How trainees should try to learn a couple of important things every day (rather than everything they are told) Communication requires being open and honest including when there is imprecision The need for optimal personal behaviour during communication encounters The benefits of differing opinions in clinical care How large conferences fit in to overall educational activity How his active social life keeps him balanced The benefits of coming to work with a smile to encourage others in your team to be in a good mood How developing research activity widens our career horizon We should all be trying to improve ourselves every day The diversity of intensive care makes it the best job in medicine My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to work and to adopt some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. If you wish to connect, leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Professor Jean-Louis Vincent has had incredible influence and an imposing career. I first heard him speak 24 years ago and was mesmerized by his exuberant, passionate and entertaining presentation style on a diverse range of topics about which he seemed deeply knowledgable. I suspect many of you have heard Jean-Louis speak at a conference, with his wonderful Belgian accent. But how many of us have heard him speak about what really happens in his own clinical environment? Please enjoy listening to this episode. Andrew Davies -------------------- Show notes (people, organisations, resources or links mentioned in the episode): Twitter handle for Professor Jean-Louis Vincent: @jlvincen International Symposium on Intensive Care and Emergency Medicine (ISICEM): https://www.intensive.org/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

In this week's episode you'll hear an invigorating conversation with Francesca Rubulotta. This power-packed, enthusiastic, passionate, water polo-playing, Italian doctor, now living and working in London, UK, is seriously ambitious to help patients other than those in her ICU, mostly by advancing education using technological innovation. Francesca is a Consultant and Honorary Senior Clinical Lecturer in Anaesthesia and Intensive Care Medicine at Imperial College Medical School. She studied medicine and anaesthesia in Italy and intensive care in Belgium, but also worked in the USA and the Netherlands on a journey that arrived in London 10 years ago. Francesca has been the Chair of the past division of professional development of the European Society of Intensive Care Medicine (ESICM) and is currently the Chair of the ESICM's CoBaTrICE project. She leads and has led many other committees and organisations, and is presently the first ever female Presidential candidate in the ESICM general election (with the ballot open until June 11). Francesca has diverse clinical interests including end of life care, ethical aspects of intensive care, rapid response systems, and clinical research. She speaks 5 European languages, travels and speaks around the globe and has won masters world championships as a waterpolo player. In this conversation, Francesca demonstrates a deep understanding of, a strong passion for and substantial experience in running educational programs and courses in an innovative way using digital technology. She also tells of her desire to maximize the reach of education to less-developed areas of the world and her hope for more balance between the genders in intensive care. We also cover: The story of her multinational career so far How she obtained her current job in the United Kingdom How her intensive care career began by translating her intensivist father's slides into English as a high school student How both she and her sister are now intensivists The benefits of training under some of the superstars of intensive care Her observation that the best intensivists keep it simple A story about how her change in demeanour helped her team understand how a clinical situation had turned serious The importance of empowering junior staff to make decisions Her fundamental desire to have daily physical contact with each patient How she took an ex-long-term ICU patient to the pub Raised expectations that educators should now deliver TED-like talks The honour of standing as an election candidate to be ESICM President The possibility of a global intensive care society one day Her passion for waterpolo and the vital importance of following our passions outside of medicine How yoga helps her look after her mind Learning from the mistakes she has made along the way And some thoughts about gender inequality in intensive care. My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to work and to adopt some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. Feel free to leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies -------------------- Show notes (people, organisations, resources or links mentioned in the episode): Link to Francesca Rubulotta's ESICM President campaign: https://mailchi.mp/b3364cf0ed73/francesca-rubulotta-esicm?utm_source=mailchimp&utm_campaign=030026c6e1f0&utm_medium=page Francesca Rubulotta's logo, suggesting representation (globe), education (eye) and innovation (light): Twitter handle for Francesca Rubulotta: @frubulotta Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

This week is International Nurses Week culminating in International Nurses Day on Saturday May 12th, the date on which Florence Nightingale was born. To celebrate this, my special guest this week is an intensive care nurse, Claire Davies. Claire is my wife. To me, she is intelligent, caring, kind and compassionate, as both a nurse and a person. So after struggling for a while with the choice of who I should have as my first nurse guest on the podcast, it gradually became obvious that it should be Claire. Claire began as an intensive care nurse back in 1999 as a Critical Care Course student at the Alfred Hospital's Intensive Care Unit in Melbourne. After rising to become an Associate Nurse Unit Manager there a few years later, Claire took time off to rear our 2 beautiful daughters before reestablishing herself as a Critical Care Liaison Nurse at the Epworth Hospital, also in Melbourne. Whilst Claire is definitely an excellent nurse, with a keen focus on developing healthy and valuable nurse-doctor relationships which place the patient's needs above anything else, she is also the long-suffering partner of an intensivist, me. This gives Claire the perfect perspective to talk about being an intensivist's partner, something we do towards the end of this conversation. We also talk about: Her career journey What is it like being an intensive care nurse The dynamic and challenging environment of an ICU The characteristics of good intensive care doctors An instance where she confronted an intensivist about how she felt intimidated by him The aim to bring everything back to being about the patient Communication between ICU doctors and nurses How nurses are good at pattern recognition How important decisiveness is Respecting and not unfairly judging prior clinical decisions Drug and other types of errors An interesting tale of one of her patients falling out of bed How Claire felt in the period afterwards and how she dealt with it Communicating in family meetings, including the use of silence Prioritising rest to bring her best self to work Some other wellness habits including eating well, exercise and yoga Seeing the drinking of water as an important goal during a shift The "funny jokes" intensivists often tell on their ward rounds Her thoughts to help intensivists be more connected to their partners and families Her interest in a more focused acknowledgement of death in the ICU when it happens My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. Feel free to leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies -------------------- Show notes (people, organisations, resources or links mentioned in the episode): Twitter handle for Claire Davies: @cldavies22 Instagram handle for Claire Davies: @clairedavies22 New Normal Project podcast: http://newnormalproject.libsyn.com/ Insight Timer app: https://insighttimer.com/ Dr Craig Hassed: https://www.monash.edu/medicine/spahc/general-practice/about/staff-students/hassed Study focusing on the "Sacred Pause": https://www.ncbi.nlm.nih.gov/pubmed/29618221 5th SG-ANZICS Asia Pacific Intensive Care Forum: www.sg-anzics.com Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Email Andrew Davies: andrew@masteringintensivecare.com Twitter handle for Andrew Davies: @andrewdavies66

Does each bedside decision you make actually help your patient to feel, function or survive? Have you considered how frightening and intimidating the Intensive Care Unit environment is to your patients and their families? Do you feel empowered by the people you work with and the culture in your ICU? Simon Finfer loves telling a tale. In this episode you'll hear the story of the serendipitous and multi-national route Simon took to end up working for 25 years in one of Australia's premiere Intensive Care Units. An Intensive Care Department where his colleagues and the culture they developed has fostered him to become one of Australia's prominent intensive care researchers. You'll also hear how he teaches his junior colleagues to question everything they do at the bedside to ensure their decisions truly help the patient. Simon is a Professorial Fellow in the Critical Care and Trauma Division at The George Institute for Global Health, a Senior Intensivist at Royal North Shore Hospital and Director of Intensive Care at the Sydney Adventist Hospital in Sydney, Australia. He is an Adjunct Professor at the University of New South Wales, a Clinical Professor at the University of Sydney and is a past-Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Simon is a world leader in Sepsis and is an international expert in the design and conduct of large scale randomised controlled trials in Intensive Care. Simon has collaborated with me (and many others) through the ANZICS Clinical Trials Group, so we caught up at the Group's recent 20th Annual Meeting on Clinical Trials in Intensive Care at Noosa Heads in Queensland. We had a fascinating conversation in which Simon talked about: His early career in London where he was simply working too hard The circuitous route he took to Royal North Shore Hospital in Sydney The magnificent people-oriented culture inspired by Malcolm Fisher His early collaboration with the George Institute for Global Health How showing you care is what matters most in an end of life discussion His thoughts on having family at the bedside for ward rounds How the golf course is the only place he doesn't think about patients How moving to a property with animals has brought relaxation and peace The rekindling of his passion for motorbike riding Why he got a Twitter account and how social media is both a force for good and an echo chamber How it's almost "too easy" to write a paper in modern times The unlikelihood of a magic bullet arriving anytime soon His advice to look after our selves, to embrace uncertainty and to maintain our humanity My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies -------------------- Show notes (people, organisations, resources or links mentioned in the episode) 5th SG-ANZICS Asia Pacific Intensive Care Forum: www.sg-anzics.com ANZICS Clinical Trials Group: http://www.anzicsctg.org/ More information about Simon Finfer: https://www.georgeinstitute.org/people/simon-finfer Twitter handle for Simon Finfer: @icuresearch SAFE study: https://www.ncbi.nlm.nih.gov/pubmed/15163774 NICE-SUGAR study: https://www.ncbi.nlm.nih.gov/pubmed/19318384 SMACC: https://www.smacc.net.au/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/ Email Andrew Davies: andrew@masteringintensivecare.com Twitter handle for Andrew Davies: @andrewdavies66