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. Flavia is the Professor of Intensive Care at the Federal University of São Paulo in São Paulo where she is Head of the Intensive Care Section of the Anesthesiology, Pain and Intensive Care Department. Flavia has trained in Internal Medicine, Infectious Diseases and Critical Care, making the field of sepsis something she has become a world leader in. She is one of the Founders of and now the CEO of the Latin America Sepsis Institute (LASI), having been its President. LASI is devoted to quality improvement in Brazilian hospitals as well as to coordination of multicenter studies in the field of sepsis. She is part of the executive board of the Global Sepsis Alliance and the executive committee for the World Sepsis Day. Flavia has served on the board of the Surviving Sepsis Campaign International Guidelines. She is also a member of both the Executive and Scientific Committee of the Brazilian Research in Intensive Care Network-BRICNET. Finally, Flavia is the editor-in-chief of "Revista Brasileira de Terapia Intensiva", the official journal of the Brazilian Critical Care Association and the Portuguese Critical Care Association. In this conversation we also cover topics including: Raising awareness of sepsis through the Global Sepsis Alliance Mentoring and being mentored The need for a multi-professional program in ICUs with a multi-disciplinary ward round Setting goals and using checklists How the limited resources in Brazilian healthcare require strict admission rules The use of simple and short protocols based on the evidence How to best deal with conflict with another doctor Using dinner time to connect with family How running is good for the mind The joys of reading books With this podcast 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. If you have a comment or a question, let's engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrew@masteringintensivecare.com or engage in the facebook page Mastering Intensive Care.

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 support. Topics like airway management, acute respiratory failure, mechanical ventilation, haemodynamic monitoring, management of shock, interpretation of arterial blood gases, transport of critically ill patients, severe trauma, neurological emergencies, oliguria & acute renal failure, cardiopulmonary resuscitation, arrhythmias, nutrition, sedation and analgesia, etc. This week my guest is Charles who is Professor in the Department of Anaesthesia & Intensive Care at The Chinese University of Hong Kong. In his words, his minor claims to fame are persuading some friends to write the BASIC course and denying a British prime minister entry to a London Intensive Care Unit, and his remaining ambition is to become a professional chef. That's all he wanted me to say about his background but let me say that having resident doctors rapidly brought up to speed on basic intensive care skills and practice, mostly so that they can feel comfortable at the ICU bedside in their first few weeks, is something I think is hugely valuable, not only to them, but also to me as a consultant and especially our patients. So that makes Charles a hero in my eyes. Of course, BASIC has gone on to now consist of many other courses, which now help up-skill nurses, medical students, advanced trainees, consultants (by providing refresher courses) in many countries, including in the developing world. So I think Charles is a legendary educator, an inspiring leader and an outstanding clinician. He is softly spoken, humble, unassuming but incredibly well considered. He powerfully helps the patients in his own ICU and dramatically helps patients all around the world by providing BASIC. What a master. In this week's episode you will hear all about the BASIC course, how it came to be, and where it is right now in amongst the other work of the BASIC Collaborative. You'll also hear Charles speak about: How he became both a doctor and an intensivist by accident How difficult it is to objectively judge the value of education The prime importance of putting the patient first in clinical, academic and educational practice Understanding the good and bad that surrounds us in our Intensive Care department culture How ICU specialists are like the hotel concierge of the hospital How paying back the support we received as trainees to our upcoming trainees is vital to the system of ICU education His views on sleep, cycling to work and listening to music The story of being on duty in a London hospital after a train crash people The benefits of communicating humanely to our patient's families when things are not going well And, how there is compulsory retirement at age 60 in Hong Kong 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. If you have a comment or a question, let's engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrew@masteringintensivecare.com or engage in the facebook page Mastering Intensive Care. Thanks for listening. Do the best you can for those unfortunate people in our ICUs we call patients, and strive to get better at what you do, whilst looking after yourself. Show notes (people, organisations, resources or links mentioned in the episode) Prof Charles Gomersall: https://www.cuhk.edu.hk/med/ans/prof_gomersall.htm BASIC course: https://www.aic.cuhk.edu.hk/web8/BASIC.htm

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. He has published papers and given talks widely. He was a founding member of the Canadian Resuscitation Institute; and was previously Medical-Lead for Simulation, Residency Program Director, and Education Lead at the University of Alberta. He is proudest of his two children, neither of whom care one iota what titles he may or may not possess. He is convinced that happiness rests in finding meaning and showing gratitude - he occasionally succeeds. This is the second in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. In addition to the human factors described above, we also spoke at length about burnout, its relationship to resilience, and the potential benefits of both working less (like part-time) and of having eccentric hobbies or passions. Peter spoke on several other topics including: His life journey from growing up in the United Kingdom to becoming a Canadian for all of his adult life The country of Canada, it's national identity and it's intensive care system The hallmarks of good teams Rudeness and its iatrogenic effects (including when family members are rude) The components of communication – including verbal, paraverbal and non-verbal A situation when Peter was accused of unprofessional behaviour and how he dealt with that How Peter has used a mini-sabbatical to reflect and to think about the next part of his career Exercise and the risk that it, other hobbies and material things can become like fetishes How our careers can be broken into thirds of "learning, earning and returning" but that we should consider all three in even the smaller periods like weeks or months The benefits of having an identity that is more than simply being a doctor His time on a cruise ship where he worked as an anonymous doctor How he is more proud of his writing of poetry and travel-writing than some of the medical papers he has published. 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. You can send any comments through the Life In The Fast Lane website, facebook (masteringintensivecare), twitter (@andrewdavies66) or by simply emailing andrew@masteringintensivecare.com. Show notes (people, organisations, resources or links mentioned in the episode): Dr Peter Brindley: https://www.ualberta.ca/medicine/about/people/peter-brindley DasSMACC website: https://www.smacc.net.au/ Dr Sara Gray: https://saragray.org/ Dr Chris Hicks: http://stmichaelshospitalresearch.ca/researchers/christopher-hicks/

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 University of Aberdeen and an Honorary Professorial Fellow at the George Institute of Global Health in Sydney. Brian's research interests include improving outcomes from critical illness and major surgery. He has over 135 peer-reviewed publications and $17 million of research grants as well as playing a leading role in a number of key clinical guidelines. Brian was very keen to talk about how much he values the human factors we all need to concentrate on to be the best we can be. Some of the main topics of discussion include: Brian's love for intensive care, which began with the machines and is now much more about humans The benefits he has realised from having high-class mentors in different areas His role as a mentor to others and how there needs to be some structure to this relationship How leadership at the bedside is like conducting an orchestra where everyone needs to be heard The need for senior trainees to stay in charge of resuscitation teams even when the consultant arrives How being a good team-player often requires us to drop our egos The value of good habits at the start of a ward round The need for department heads to address their team member's personal wellness requirements to maximise vitality and balance The importance of family members being at the bedside on clinical rounds to represent the values of the patient The fact that the highest level skill we can have is the ability to lead a family meeting, especially in culturally-diverse cities Placing the patient's values and needs at the centre of any inter-professional discussions, particularly differences in opinion The requirement for greater academic study of all of these non-technical skills 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. If you wish to send a comment or respond to something Brian 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. Please take the very best care of your patients, their families and your colleagues. And above all, consider that taking care of yourself might actually be the best thing you can do for your patients. I hope you have a great week. ____________________________________________________________________________________________ Show notes (people, organisations, resources or links mentioned in the episode) Sunnybrook Health Sciences Centre: http://sunnybrook.ca/ Brian Cuthbertson: http://sunnybrook.ca/team/member.asp?t=17&page=2780&m=407 Malcolm Fisher: http://www.nslhd.health.nsw.gov.au/newsevents/Pages/MalcolmFisherICU.aspx Nigel Webster: https://www.abdn.ac.uk/ims/profiles/n.r.webster Marion Campbell: https://www.abdn.ac.uk/hsru/people/m.k.campbell/ Mentorship in Academic Medicine – Author Sharon Strauss: http://www.mentorshipacademicmedicine.com/ Atul Gawande: http://atulgawande.com/

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. ____________________________________________________________________________________________ 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/

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 and since then she has played a key role in the development of the internationally respected King's liver service, including the expansion of the hospital's intensive care bed capacity. Her primary clinical areas of interest are severe liver injury, multi-organ failure, immune dysfunction and the role of extracorporeal therapies for the management of acute liver failure. She is a respected academic, has published over 150 papers, and is regularly invited to lecture at national and international conferences. Julia is an articulate, thoughtful, caring and compassionate intensivist, as well as a tremendous stage presenter. Julia was an international speaker at the Australian and New Zealand CICM ASM in Sydney in May 2017 and this gave me a brilliant opportunity to interview her. Having helped to develop a world-leading liver ICU service at King's, Julia gives highly useful reflections on how noone can achieve anything without colleagues and great teamwork; smiling, saying hello and thank you is an important role of being a consultant leader; seeking second opinions is a really valuable regular practice to make sure we aren't missing anything; learning from trainees who have come from other continents and cultures is a huge privilege; looking after patients should always come before attending hospital meetings; and how she revels in allowing less experienced people to step forward and grow so that they can eventually overtake her. Also hear Julia speak about how: After enjoying intensive care as a very junior doctor working on a cardiac ambulance team, she trained at Middlesex Hospital in London under role models like David Bihari and Jack Tinker, who taught physiology enthusiastically at the bedside She learned so much from the senior intensive care nurses in her younger days Intensive care careers sometimes need to be varied in pace, and even head off in different directions at times Much can be gained by visiting other colleagues ICUs and even doing a ward round to see how others interact and manage patients She often reflects over a cup of tea on how a day in the ICU went and how she could have done things better The running of a family conversation can be difficult, is often done better by some than others, is a learnable skill, and requires accurate knowledge of what is happening with the patient, as well as asking the family what their present understanding is, all with the aim that the family can cope with the memories that they will leave with Making time for the important things in our lives helps us manage stress; and for Julia this includes clinical work, reading papers, reflecting, doing research, spending time with family, cooking and skiing Everyone in a department has different needs, and these should be recognised so that people can be allowed to do what fits with their needs, whether that be research, education, management or even playing golf Starting a 7 day week on a Friday can allow for some relief on the sixth or seventh consecutive day if this is required; which is less possible if the week starts on a Monday She would love to go back and study pure mathematics She worries we think about stress and burn out but that we don't do enough planning for what we will do when we are finished medicine We could use our journal clubs to allow us to present our favourite life habit to our colleagues Handover has become a greater responsibility as ICU teams have got bigger 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 helped spread the word by simply emailing your colleagues or posting on social media. If you want to send a comment or respond to something Julia 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 the hashtag #masteringintensivecare. Thanks so much for listening. Please give your patients the very best care you can, and take care of yourself too.

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 mid-1990's. Colin currently leads research governance for New Zealand's largest clinical research facility at Auckland City Hospital, and holds adjunct/honorary appointments at Auckland and Monash Universities. He is married to Juliet and has 3 sons in their early 20's. Colin is currently in transition from being a keen runner to (in his words) a mediocre cyclist. Colin is wise, thoughtful, hugely supportive, skilled in many areas, and highly experienced, making what he says all the more useful to intensivists and trainees at all levels. Having been a leader for much of his career, he encourages trainees to find out how intensive care is delivered in many different institutions, both locally and internationally; he describes how although self-reflection is important, hearing the views of others on our performance is even better; he discusses his attitude to sleep and how the hours before midnight count most; and he tells how the benefits of running for him have included ensuring regular exercise, helping manage stress, and weight control. Also hear him speak about how: He found ICU an intimidating place when he first transferred patients from surgery as an anaesthetic trainee but began to like the people who worked there He worked for 2 years in Hong Kong and learnt from Dr Teik Oh, a pioneer and true master of intensive care in the Asian and Australasian region Senior mentors in our career can teach us about communication, interacting with others and the other highly important non-technical skills Working in an ICU that might be considered strong has good and bad aspects but does provide leadership in looking after the sickest patients Intensivists need to grow in their careers to operate at a level above simply having basic clinical skills so as to allow the main focus to be overall patient management through coordination and communication We can learn from seeing things done both well and done poorly The days in which he feels he is not at his best are usually related to what he has brought to work by not being well rested, not being well fed or not having done exercise He likes to get to work a little bit early to enable social interaction prior to the work phase of the day Tough he finds it to keep the details of more than 12 patients in his mind A really good stress management strategy is to carefully pick our battles Most intensivists would benefit from having a string to their bow other than simply clinical work Speaking to families and patients requires regular and multiple interactions, honesty, frankness, recognition of uncertainty, recognition of the limitations of medical knowledge and the need to value what the families bring to the conversation 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 more masterfully interact with our patients, their families and our fellow health professionals to deliver the most satisfactory outcomes to all. It would be much appreciated if you helped spread the word by simply emailing your colleagues or posting on social media. If you wish to send any feedback or simply want to keep the conversation from this episode going, please leave a comment on this page, go to the Mastering Intensive Care page on facebook, post on twitter using #masteringintensivecare or send an email to andrew@masteringintensivecare.com.

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 felt the frustration of being a woman in intensive care when she has noticed behaviours that in retrospect she has wondered whether men would ever have been subjected to. Imogen also struggled to find the perfect mentor earlier in her career, perhaps because of the scarcity of female intensivists at the time. She now wants to make sure young female medical students and intensivists come to understand that intensive care can be an excellent career for both genders. Imogen is thoughtful, intelligent, compassionate and considerate. She has been a leader for most of her career, making her the ideal person to give us advice on leadership, communication, decision-making, the training of young doctors, and debriefing to manage stress. In this interview, Imogen starts with how she came to fancy intensive care over her initial desire to be a histopathologist, and ends with some great "life" tips for less experienced clinicians. 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 from Frankston Hospital in Melbourne, Australia, speaks 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. Please send any comments through the Life In The Fast Lane website, facebook (masteringintensivecare), twitter (@andrewdavies66) or by simply emailing andrew@masteringintensivecare.com.

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 through their critical illness. Whether they are on an upward trajectory to improvement, whether they are on a downward trajectory that may lead to death, or whether they are stuck on the flat "curve" which we often don't have our eyes open to. John also tells us to be careful of using too many "toys" (machines) and focusing too much on the test results. And he warns us that we are at point in the development of intensive care medicine where we save the lives of more people, but forget to realise that many of these have a greater disease burden from their chronic critical illness than they did when they were admitted to the ICU. 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 from Frankston Hospital in Melbourne, Australia, speaks 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. Please send any comments through the Life In The Fast Lane website, facebook (masteringintensivecare), twitter (@andrewdavies66) or by simply emailing andrew@masteringintensivecare.com.

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 things get out of control; the importance of training in communication (and recognising that honesty and respect can be more important than understanding everything about other cultures); the benefits of talking about what is important to a patient's family, not what is important to us; the realisation that she needed a mid-career mental health break (which she had in Fiji just last year); and her desire to continue to improve at connecting with patients, families and colleagues. 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 from Frankston Hospital in Melbourne, Australia, speaks 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. Please send any comments through the Life In The Fast Lane website, facebook (masteringintensivecare), twitter (@andrewdavies66) or by simply emailing andrew@masteringintensivecare.com.