Mastering Intensive Care

This week's guest, Australian intensivist Dr Ed Litton, truly amazes and inspires me. Despite having a full-time clinical and research career, and a young family, Ed pursues his passion for adventure mostly through ultra-endurance exercise.

Many intensivists run, swim, cycle or do other sorts of vigorous exercise in their spare time. Some even run marathons, swim regularly with a squad or cycle long distances to and from work. Some do all 3 by competing in triathlon events. Yet not too many intensivists take on ironman triathlons like Ed does. And how many cycle across Australia from Sydney to Perth as he did a couple of years ago?

Ed uses adventure and exercise to keep refreshed for his busy medical career. So to me this podcast conversation is a real treat. Hearing about this massive cross-continent bike ride, the recent family cycling trip across the New Zealand Alps he and his wife did with their 2 young children, and his love for other physical pursuits like surfing and climbing, is both educational and inspiring.

Ed Litton is a Staff Specialist in Intensive Care Medicine and Director of ICU Research at Fiona Stanley Hospital in Perth, Australia, and a Clinical Research Fellow in the ICU at St John of God Hospital in Subiaco. He is the recipient of a National Health and Medical Research Council Early Career Fellowship and is a Clinical Senior Lecturer at the University of Western Australia. Ed is a member of the executive committee of the Australia and New Zealand Intensive Care Society Centre for Outcomes Research Evaluation where he is clinical director of the Critical Care Resources Registry. He's received over $6M in research support and published over 60 manuscripts in the peer reviewed literature.

I have admired Ed and his thoughtful approach to intensive care and to life for several years now. Apart from his approach to adventure and exercise he has many valuable perspectives on his bedside approach including:

• What fascinates him about Intensive Care
• Some of the things he learnt from his key mentors
• The importance of reassurance for patients
• Mixing patient-centred and digital information
• The 2 phase ward round at his ICU
• The internal pressure he felt as a new consultant to make fast decisions
• Creating the right atmosphere in communicating with colleagues
• His tendency to ruminate about his patients
• Fatigue during ward rounds
• His thoughts on sleep
• How he uses meditation
• The value of reading books
• The difficulty in trying to be a jack of all trades in our careers.

Ed is caring, mature and very patient-focused. He's also a super fit athlete. Please enjoy listening to the podcast.

Andrew Davies

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About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit through conversations with thought-provoking guests. I hope you'll hear perspectives to help you improve as a healthcare professional and as a human being with the aim of helping your patients receive the best possible care.

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Links to people, organisations and other resources mentioned:

Ed Litton on Twitter: @ed_litton

Article about Ed Litton's bike ride across Australia

Alex Psirides

Simon Finfer

Muse

Rottnest Island swim

New Normal Project podcast

New Normal Project podcast - episode 48 with Caldwell Esselstyn

New Normal Project podcast - episode 49 with Scott Stoll

Book "In Shock" (by Rana Awdish)

Mastering Intensive Care podcast

Mastering Intensive Care page on Facebook

Mastering Intensive Care at Life In The Fast Lane

Andrew Davies on Twitter: @andrewdavies66

Andrew Davies on Instagram: @andrewdavies66

Email Andrew Davies

Happy New Year. Here's hoping 2019 is a great one for you.

Mastering Intensive Care is aimed to inspire and empower you, as an intensive care clinician, to bring your best self to the ICU, through conversations with thought-provoking guests. I think there's a gap in education on the topics we cover on this show and hopefully you find my guests useful.

During the Christmas/New Year period I listened to all of the episodes I published in 2018. This allowed me to learn what I can do better as a podcaster and to package up the best bits of a year's worth of podcasts into something I think is valuable on its own. It truly astounds me how extraordinary the advice, perspectives and stories of my guests are and I hope you find something to help you in most episodes.

I couldn't include all 2018 guests on this episode so I picked the best excerpts in my humble opinion. I am sorry if I chose a guest (or left out a guest) that you would not have. If you've heard them before it should jog your memory. If you missed some of the episodes it helps you to catch up on them. If you are a new listener this is a flavour of what this show is all about.

I hope you enjoy what I see to be a crash course of what we covered during 2018 and one that can help you to bring your best self to work in 2019.

Thanks for listening.

Andrew Davies

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People, organisations and resources mentioned in the episode:

New Normal Project podcast – Episode 46 with Andy Ramage

OYNB challenge

MIC Episode 32 with Kate Harding

MIC Episode 38 with June Goh

SG-ANZICS Asia Pacific Forum

Singapore SICM

ANZICS

MIC Episode 35 with Paul Wischmeyer

MIC Episode 27 with John Santamaria

MIC Episode 28 with Simon Finfer

MIC Episode 25 with Sarah Yong

MIC Episode 33 with Wes Ely

MIC Episode 29 with Claire Davies

New Normal Project podcast

Mastering Intensive Care podcast

Mastering Intensive Care page on Facebook

Mastering Intensive Care at Life In The Fast Lane

Andrew Davies on Twitter: @andrewdavies66

Andrew Davies on Instagram: @andrewdavies66

Email Andrew Davies: [email protected]

How well do you know your colleagues?

How much do you socialise with them?

Do you have an annual retreat for your colleagues and their families?

After you listen to this episode you may reflect on these questions. To give your patients the very best care possible it seems obvious that your team needs to know each other, understand the strengths and weaknesses of each other, and combine and communicate well in the clinical environment.

So how much time does your department devote to fostering a department culture that feels like a family? Including getting to know each team member's actual family. How much do you do? My Intensive Care department does this pretty well but we could always do better. And we haven't done a retreat in my time working there.

In the final episode of 2018, you'll listen to Dr June Goh who is all about fostering such a family environment. She came up with the idea of taking her colleagues and their families on an annual weekend retreat over a decade ago. And she organises regular resident and medical officer engagement sessions with fun activities. All of which I suspect brings them tighter together as a more harmonious team, thereby helping their patients.

June is a Senior Consultant in Singapore General Hospital and the Director of Neuroanaesthesia and Neurocritical Care. She is very involved in teaching both medical students and post graduate doctors as member of the Core Faculty Anaesthesia Residency Programme, Chair of the Residency Welfare Committee, Adjunct Assistant Professor Duke-NUS Graduate Medical School and Clinical Lecturer in the Yong Loo Lin Medical School. She chairs the Singapore General Hospital transplant oversight committee. June also currently serves on the Yong Siew Toh Conservatory of Music Board, Dover Park Hospice Governing Council and co-chairs the fundraising committee. She has been an active member and past president of the Association of Women Doctors Singapore (AWDS) helping out with the various activities organised by AWDS. June is currently President of the Singapore Council of Women's Organisations and is passionate about women's family and health issues.

This episode was recorded 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 live interviews for this podcast. Many thanks to Tan Hon Liang and David Ku for this opportunity.

In this conversation June also spoke on topics such as:

• Her early career
• Her perspective on Singaporean gender equality
• How she mixed bringing up her children with being a busy doctor
• Building trust and rapport to strengthen communication with patient's families
• Her perspective on some of the innovations in medical education
• Coping with work stresses to stay balanced
• Managing our device usage in the smartphone era
• Identifying and mentoring successors to our institutional roles
• Her thoughts on lifestyle factors such as yoga, exercise and sleep
• Her enjoyment of fashion

The Mastering Intensive Care podcast is aimed to inspire and empower you, as an intensive care clinician, to bring your best self to the intensive care unit, through conversations with thought-provoking guests. My hope is that by listening to the show you'll hear at least one thing to help you improve, as either a healthcare professional or as a person, with the ultimate aim of helping your patients.

Please help me to spread the message by simply telling one of 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 [email protected].

This is an enjoyable, thought-provoking and wide-ranging discussion with a woman doctor who is advancing the cause of women in and out of medicine whilst also compassionately caring for her patients and her team

Thanks for listening.

Andrew Davies

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People, organisations and resources mentioned in the episode:

June Goh at Singapore Council of Women's Organisations: http://www.scwo.org.sg/about-us/who-we-are/dr-june-goh/

June Goh at Association of Women Doctors (Singapore): http://www.awds.org.sg/dr-june-goh/

SG-ANZICS Asia Pacific Forum: http://sg-anzics.com/

Human Organ Transplant Act (Singapore): https://www.gov.sg/factually/content/what-is-hota-all-about

Article by June Goh on Gender Equality: https://www.channelnewsasia.com/news/singapore/commentary-on-gender-equality-and-whether-women-can-have-it-all-9114542

June Goh featured in Bazaar Magazine: https://www.harpersbazaar.com.sg/exclusives/bazaar-magazine/bazaar-stylish-women-2017-june-goh-rin/

June Goh featured in The Peak Magazine: https://thepeakmagazine.com.sg/interviews/june-goh-doctor-teacher-family-woman-fashionista/

New Normal Project podcast: http://newnormalproject.libsyn.com/

New Normal Project podcast - Episode 45 with Neal Barnard: http://newnormalproject.libsyn.com/episode-45-neal-barnard-how-to-start-plant-based-eating-and-which-health-benefits-you-might-expect

New Normal Project podcast - Episode 46 with Andy Ramage: http://newnormalproject.libsyn.com/episode-46-andy-ramage-using-an-alcohol-free-challenge-to-reframe-your-relationship-with-alcohol

Mastering Intensive Care podcast - Episode 37 with Michael O'Leary: http://masteringintensivecare.libsyn.com/episode-37-michael-oleary-dealing-with-the-frustrations-of-the-changing-icu-landscape-sg-anzics-special-episode

Book: "In Shock" (by Dr Rana Awdish) https://www.ranaawdishmd.com/book

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: [email protected]

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 [email protected].

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: [email protected]

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 [email protected].

Thanks for listening.

Andrew Davies

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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: [email protected]

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 [email protected].

Thanks for listening.

Andrew Davies

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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: [email protected]

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 [email protected].

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

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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: [email protected]

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 [email protected].

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

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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: [email protected]

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 [email protected].

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.

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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: [email protected]

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 [email protected].

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

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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: [email protected]