My guest in this episode is Dr Emily Amos, a general practitioner and a passionate educator on mindfulness in Melbourne. Emily might not be an intensivist but she is a doctor with a powerful burnout story that led to her becoming an enthusiastic guide and teacher about mindfulness and self care. Emily has roles as a GP, a surgical assistant, a lactation consultant, a yoga teacher, a university tutor and a registered mindfulness meditation teacher. Her business, Whole Hearted Medicine, runs mindfulness & self care retreats for doctors. These immersive, CPD approved retreats offer doctors the chance to learn skills in mindfulness, meditation and self compassion away from both work and family pressures. Emily also blogs, speaks, podcasts, runs workshops, and offers several courses through her website www.dremilyamos.com. Emily provides excellent perspectives on burnout, wellbeing, mindfulness, stress management, life balance and psychological safety. On this episode, Emily openly shares her vivid recollection of the day her life fell apart, what she discovered about herself during her recovery, and, most importantly, how this fuelled her subsequent drive to guide and support people, including doctors, through mindfulness-based self care. Thank you for listening to Dr Emily Amos. -------------------- About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to work, with a focus on compassion, collaboration and personal wellbeing. -------------------- Relevant links Dr Emily Amos Emily Amos website with links to courses, podcast, blog and other useful material Emily Amos on Instagram Emily Amos on Facebook Emily's mind.life.me podcast Whole Hearted Medicine retreats Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on X (Twitter): @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

My guest in this episode is Dr Peter Brindley, an intensivist and Professor of Critical Care in Edmonton, Canada. Peter is a deep thinker, a compassionate bedside doctor, and a passionate educator, researcher, and writer about many of the human-focused topics that this podcast likes to focus on. He was previously featured in episode 15 as well as in the Persevering Through A Pandemic series from 2021. These episodes are well worth listening to. Given he was in Australia for the Annual Scientific Meeting of the CICM, I thought I had to have him on the show again. In this episode, Peter talks about why he’s a doctor and why he stays working where he does, before touching on a variety of topics including clinical leadership, imposter syndrome, the differing skills of the people making up our teams, efficiency, understanding when patients are dying, podcasting, wellbeing and parting advice. Thank you for listening to Dr Peter Brindley. Andrew Davies -------------------- About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to work, with a focus on compassion, collaboration and personal wellbeing. -------------------- Relevant links Peter Brindley Opinion piece "Diagnosing dying: is it time for doctors to write 'dying certificates'?" (by Peter Brindley & Matt Morgan) Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 15 with Peter Brindley Mastering Intensive Care podcast - Persevering Through A Pandemic - Series Trailer Mastering Intensive Care podcast - Persevering Through A Pandemic - 1 - Sick Of COVID Mastering Intensive Care podcast - Persevering Through A Pandemic - 2 - It Was Inconceivable Mastering Intensive Care podcast - Persevering Through A Pandemic - 3 - Ultramarathon Mastering Intensive Care podcast - Persevering Through A Pandemic - 4 - Best & Worst Year Mastering Intensive Care podcast - Persevering Through A Pandemic - 5 - 'Life' Support For Our People Mastering Intensive Care podcast - Persevering Through A Pandemic - 6 - Learnings We Might Take Away Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on X (Twitter): @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Mastering Intensive Care is back after a long hiatus between episodes, and a fun divergence into a series about at athletic adventure. This episode features Dr Andrew Holt, a highly experienced intensivist at Flinders Medical Centre in Adelaide, who was one of the mentors who significantly shaped my career. You’ll discover why Andrew was pivotal in my journey, what he sees as the key aspects of a good intensivist, what he has done in coaching and supporting trainees, how he was nearly waylaid by an early career mishap, and what's been profoundly challenging him in recent years. This conversation is personal, candid, sombre and essential listening - even if it has taken me longer to publish than I would have liked. I’m grateful to Andrew for courageously and vulnerably sharing his recent difficulties in amongst some valuable lessons and wisdom. Thank you for listening to Dr Andrew Holt. Andrew Davies -------------------- About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing. -------------------- Relevant links Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on X (Twitter): @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Thank you for listening to the ninth and final episode of the Mastering Intensive Challenges - Run Larapinta series. If you’ve listened to the series, you’ll know my friend Ed Litton and I entered a four-day stage trail running event, the Run Larapinta Stage Race, and ran, climbed, descended, scrambled and walked with 200 other enthusiastic participants along a mountainous and rugged trail in the spectacular red centre of Australia. Ed and I thought these conversations on the podcast might help others in setting and completing endurance exercise challenges, something we both prioritise in supporting our well-being to keep bringing our best selves to work in the ICU. In this episode, we thought we’d record a final episode to reflect on how we have recovered, what the whole experience meant, what we learned from the challenge and what might be next for each of us? Thank you for listening.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Relevant links Image Credit: James Tudor from Forktail Ed Litton on Twitter: @ed_litton Ed Litton at University of Western Australia Ed Litton on Strava Andrew Davies on Strava Run Larapinta Stage Race Mastering Intensive Care podcast - Episode 40 with Ed Litton Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 1 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 2  Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 3 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 4 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 5 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 6 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 7 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 8 Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care page on Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies

This is the 8th episode of the "Mastering Intensive Challenges - Run Larapinta" series and if you’ve been listening to the previous ones, you’ll know that this episode is coming out after the four day stage race that fellow intensivist Ed Litton and I set ourselves the challenge of running many months ago. Two Intensive Care doctors, both novices at trail running, looking for something moderately hard, something we could do together, and something we could talk about on the show to hopefully inspire you and other listeners to go for a run or to set yourself your own exercise challenge. We’ve had regular conversations in the lead up to the event, held from August 24th-27th, on the spectacular Larapinta trail, near Alice Springs in the red centre of Australia, and now it’s time to tell you how it all played out. Did we make it? Were there obstacles? How hard was it? And did it measure up to our expectations? Thanks for listening.   Andrew Davies --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Relevant links Ed Litton on Twitter: @ed_litton Ed Litton at University of Western Australia Ed Litton on Strava Andrew Davies on Strava Run Larapinta Stage Race Mastering Intensive Care podcast - Episode 40 with Ed Litton Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 1 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 2  Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 3 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 4 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 5 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 6 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 7 Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care page on Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies

Fellow intensivist Ed Litton and I signed up for a big challenge 10 months ago when we registered to run in the Run Larapinta, a 4-day stage race in central Australia. We’ve both completed many endurance events, however neither of us have done any serious trail running nor have we ever run 130km in 4 days on a rocky and mountainous trail like the beautiful Larapinta trail in the Northern Territory of Australia. It’s now only a week away so Ed and I had a conversation to update each other on our recent training before answering 5 questions we thought were worth asking each other at this final stage of our preparations. What’s worked well in our preparations? What’s not worked well in our preparations? What’s the focus of the remaining time? What have we learned from taking on this challenge? What is exciting us about the upcoming challenge? We hope you’ll enjoy listening to the conversation, and that it might inspire you to get out for a run or for any type of exercise that suits you. Thanks for listening.   Andrew Davies --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Relevant links Ed Litton on Twitter: @ed_litton Ed Litton at University of Western Australia Ed Litton on Strava Andrew Davies on Strava Run Larapinta Stage Race Mastering Intensive Care podcast - Episode 40 with Ed Litton Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 1 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 2  Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 3 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 4 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 5 Mastering Intensive Care podcast - Mastering Intensive Challenges - Run Larapinta - Episode 6 Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care page on Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Episode notes coming soon....

This is the fifth episode in the Mastering Intensive Care - Run Larapinta series. Ed Litton and I are back on opposite sides of Australia, and neither of us has had the perfect three weeks since we last chatted. There are now less than seven weeks until the event starts, so we chat about our training, then swing over to what we are each thinking about the logistical challenges we will be presented with. We hope you’ll enjoy listening to the conversation, even if you prefer the couch to your running shoes. If we can inspire you to get out for some exercise, that would be even better. Thanks for listening.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing. --------------------   Relevant links Ed Litton on Twitter: @ed_litton Ed Litton at University of Western Australia Ed Litton on Strava Andrew Davies on Strava Run Larapinta Stage Race Mastering Intensive Care podcast - Episode 40 with Ed Litton Mastering Intensive Care podcast - Run Larapinta - Episode 1 Mastering Intensive Care podcast - Run Larapinta - Episode 2 Mastering Intensive Care podcast - Run Larapinta - Episode 3 Mastering Intensive Care podcast - Run Larapinta - Episode 4 Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care page on Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Here is another episode in the Mastering Intensive Care - Run Larapinta series. For this one, I travelled to Perth to meet with my Run Larapinta co-participant Ed Litton and to head out for a few runs together over a three day weekend. We also set up the microphones to update each other with our preparations and to discuss our perspectives on the social aspects of exercise, mainly endurance sport. We talked about group training, family support, and even using the social media platform Strava to share inspiration. We hope you’ll enjoy listening to the conversation, whatever exercise you choose to do. Thanks for listening.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Relevant links Ed Litton on Twitter: @ed_litton Ed Litton at University of Western Australia Ed Litton on Strava Andrew Davies on Strava Run Larapinta Stage Race Mastering Intensive Care podcast - Episode 40 with Ed Litton Mastering Intensive Care podcast - Run Larapinta - Episode 1 Mastering Intensive Care podcast - Run Larapinta - Episode 2 Mastering Intensive Care podcast - Run Larapinta - Episode 3 Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care page on Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This is a follow on episode as Ed Litton and I continue our discussion about the Run Larapinta Stage Race we will be participating in soon. Ed and I tell each other how our running training is going. Then we talk about our general views on nutrition and sleep, especially as we lead into a multi-day endurance event. One of us has picked up a little niggle. And each of us has a different approach to what we consume during long runs. It might not be what we talk about on regular episodes of Mastering Intensive Care but we hope you’ll enjoy listening to the conversation, whether you run, walk, cycle, hike, workout in the gym, or do whatever is your style of physical activity. Thanks for listening.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Relevant links Book “Community" (by Hetty McKinnon) Book “Eat & Run” (by Scott Jurek) Rich Roll podcast Ed Litton on Twitter: @ed_litton Ed Litton at University of Western Australia Mastering Intensive Care podcast - Episode 40 with Ed Litton Mastering Intensive Care podcast - Run Larapinta - Episode 1 Mastering Intensive Care podcast - Run Larapinta - Episode 2 Run Larapinta Stage Race Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care page on Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This episode features the wise perspectives of an Advanced Trainee in Intensive Care Medicine, Dr William Bonavia. The discussion covers: Why he chose medicine and Intensive Care His training journey and his learning strategy What makes a good ward round Learning from colleagues The principles of good communication and collaboration The value of work being fun Making mistakes Dealing with the pressures of the job His thoughts on sleep, exercise, resilience and burnout Gender inequity in training The future of his career Tips for fellow trainees Will Bonavia is an Intensive Care Trainee at the Alfred Hospital in Melbourne and has previously worked at Peninsula Health ICU. He has an interest in teaching, having previously played a role in tutorial, simulation and workshop environments, as well as coordinating a training program for ICU trainees sitting the CICM first part examination. He is also interested in staff welfare and has worked as a trainee representative within his intensive care department at Peninsula Health.   Will has an interest in the long term outcomes of ICU patients and has published research in the area of delirium prediction models. He is currently working on research in the area of persistent critical illness and long term outcomes of critically ill ICU patients with COVID-19. Outside of work, Will enjoys a rotating roster of hobbies but is currently an avid squash enthusiast.  Will has a highly compassionate and careful communication-focused approach. Whether you are a trainee, a fully fledged consultant or someone else involved in the practice of Intensive Care, I hope you enjoy my conversation with Dr Will Bonavia. Andrew Davies -------------------- About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing. -------------------- Relevant links Life In The Fast Lane Book “One Billion Years to the End of the World” (by Arkady Strugatsky & Boris Strugatsky) 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In this second of a different style episode, Ed Litton and I continue our discussion about the Run Larapinta Stage Race we will be embarking on in August 2023.  Ed and I talk about our preparation and then tell each other why we run, and what we get out of it. Ed is a multi-sport endurance athlete whose reasons for getting out in nature are deep and truly inspiring. We hope you’ll enjoy hearing this conversation, whether you run, walk, cycle, hike, work out in the gym, or do whatever is your style of physical activity. Thanks for listening.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Relevant links Ed Litton on Twitter: @ed_litton Ed Litton at University of Western Australia Mastering Intensive Care podcast - Episode 40 with Ed Litton Mastering Intensive Care podcast - Run Larapinta - Episode 1 Run Larapinta Stage Race Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care page on Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This episode features the memories, experiences and wisdom of Dr Lindsay ‘Tub’ Worthley, AM. The discussion covers the following: Tub’s training to become an intensivist when no specific training existed His experience at a time when Australian ICUs were in their infancy The difference between the beginning and the end of his clinical career His eventual transition to retirement His writing of textbooks, scientific papers, editorials and a memoir What he learned about humanity in the ICU Working and communicating with various team members Enthusiastic leadership and the importance of a smooth-running team How he maintained his wellbeing His potential concern for the future of intensive care Some long-lasting career advice Tub worked as an intensive care medical specialist at the Royal Adelaide hospital ICU between 1971 and 1991, before moving to the Flinders Medical Centre ICU, where he worked until 2007. He retired from active clinical intensive care practice in 2009 although his legacy remains through his prolific writing (of scientific papers, editorials and books). Tub has been a passionate and highly respected postgraduate teacher in intensive care medicine, establishing and running the Adelaide Short Course on Intensive Care Medicine (known colloquially as “Tub’s course) from 1983 – 2005. The course continues today and is now known as the South Australian CICM Fellowship Exam Course. He created the journal “Critical Care and Resuscitation” and was the inaugural Editor-In-Chief for 6 years. He has also served as President of ANZICS, as an examiner for several Colleges and as a convener of many conferences. Tub is married to Janice and has 3 sons and 8 grandchildren, all of who he loves dearly. In 2010 he was appointed as a Member in the General Division of the Order of Australia (AM) for “Service to medical education, particularly in the area of intensive care medicine, as a clinician, mentor and educator, and through contributions to professional associations”. His books are: - Worthley LIG. Synopsis of Intensive Care Medicine. London: Churchill Livingstone, 1994. - Worthley LIG. Handbook of Emergency Laboratory Tests. New York: Churchill Livingstone, 1996. - Worthley LIG. Clinical examination of the critically ill patient, 3rd Ed. Melbourne: The Australasian Academy of Critical Care Medicine, 2006. - Worthley LIG. Inside God’s shed: memoirs of an intensive care specialist. Adelaide: JANDL Holdings Pty Ltd, 2014. Most importantly, Tub was one of the consultants responsible for my training, so this episode is a big thrill for me. Thanks for listening to a true colossus of intensive care, Dr Tub Worthley. Andrew Davies -------------------- About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing. -------------------- Relevant links "Tub's Course"  Book “Inside God's shed: memoirs of an intensive care specialist" (by Lindsay Worthley) Journal “Critical Care and Resuscitation” Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Mastering Intensive Care podcast - Episode 5 with Jamie Cooper Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

We are trying something different on Mastering Intensive Care. My friend and fellow intensivist Ed Litton has cajoled me into joining him in a running event. We will be running the Run Larapinta Stage Race in August 2023. In this episode, we commence a mini-series discussing our lead up to the event. Ed and I have different backgrounds as amateur endurance event participants, and in this episode, you’ll hear some of Ed’s endurance accomplishments, what the Run Larapinta event involves, and what we are both pondering as we start ramping up our training. If you are a runner, an endurance activity participant, a person who exercises regularly, or someone who enjoys hearing about other people’s challenges, I hope you will enjoy listening in.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Relevant links Ed Litton on Twitter: @ed_litton Ed Litton at University of Western Australia Mastering Intensive Care podcast - Episode 40 with Ed Litton Run Larapinta Stage Race 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This episode features the thoughts and perspectives of A/Prof Chris Nickson. The topics covered include: How Chris became an intensivist and then an educator How he began working on Life In The Fast Lane (LITFL) The network of Clinical Educators he leads and the “Incubator” program Simulation and debriefing The current place of FOAM and podcasts in education What he tries to achieve on his ward round Clinical leadership, team dynamics and the necessity of psychological safety The difficulties of fatigue and undervaluing sleep Other aspects of personal wellbeing His reading (including a book recommendation) The future of Intensive Care, especially after COVID-19 Advice for new intensivists Advice on teaching the human aspects of ICU Chris Nickson is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne and a Clinical Adjunct Associate Professor at Monash University. He is the Lead for the ANZCEN Clinician Educator Incubator programme, a Director of the Australia and New Zealand Intensive Care Foundation, and a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in intensive care medicine and emergency medicine; and post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professions education. Chris is involved in the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches numerous courses worldwide. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of three amazing children.  On Twitter, he is @precordialthump. Thanks for listening to my conversation with Chris Nickson.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Chris Nickson Chris Nickson at Life In The Fast Lane Chris Nickson on Twitter: @precordialthump Chris Nickson on LinkedIn Life In The Fast Lane Intensive blog   Links to other resources (in order of mentioning) David Galler Mike Cadogan Aequanimitas Clinician Educator Incubator program Cameron Knott Manisa Ghani Deb Massey Kylie Moon Steve Philpot FOAM Scott Weingart EMCrit  Academic Life In Emergency Medicine blog SMACC conference Deranged Physiology Steve McGloughlin Marcus Aurelius William Osler Book “How The World Really Works" (by Vaclav Smil) Bill Gates   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Mastering Intensive Care podcast - Episode 5 with Jamie Cooper Mastering Intensive Care podcast - Episode 45 with Scott Weingart Mastering Intensive Care podcast - Episode 59 with Steve McLoughlin Mastering Intensive Care podcast - Episode 63 with Steve Philpot Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Mastering Intensive Care is returning from being offline for a full 12 months. In this episode, I ask you to ponder, “how are you going?” after the lengthy pandemic, which has lulled after the worst of the storm but has not yet settled into a state of calm. Whilst few intensive care clinicians have actively diminished what we’ve been through over the last few years, the relentless world of Intensive Care continues unabated. There have been many learnings from the pandemic, but we mustn’t sweep the emotions we’ve witnessed under the carpet. As you listen to this shorter episode than usual, I hope you’ll ponder questions about how you have managed yourself during the pandemic, both individually and in your local ICU community. I share what I’ve witnessed in myself and my colleagues before offering a few thoughts on where we might focus our actions in recovering from what we’ve been through. Thank you for listening as I use this opportunity to reinvigorate this podcast after 12 months of languishing.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower Intensive Care clinicians through conversations about the human side of Intensive Care to bring their best selves to work by focusing on compassion, collaboration and personal wellbeing.   -------------------- Links to resources discussed (in order of mentioning) Article in New York Times “There’s a Name for the Blah You’re Feeling: It’s Called Languishing” (by Adam Grant) Article in New York Times “There’s a Specific Kind of Joy We’ve Been Missing” (by Adam Grant) Mastering Intensive Care episode - Persevering Through A Pandemic - 1 - Sick Of COVID Mastering Intensive Care episode - Persevering Through A Pandemic - 2 - It Was Inconceivable Mastering Intensive Care episode - Persevering Through A Pandemic - 3 - Ultramarathon Mastering Intensive Care episode - Persevering Through A Pandemic - 4 - Best & Worst Year Mastering Intensive Care episode - Persevering Through A Pandemic - 5 - 'Life' Support For Our People Mastering Intensive Care episode - Persevering Through A Pandemic - 6 - Learnings We Might Take Away   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This episode focuses on learnings from the COVID-19 pandemic. Important lessons our global Intensive Care community, your local ICU and you personally might take away from what the novel coronavirus has caused - at least so far. Previous episodes of this series (a series best listened to in episode order) have allowed you to hear the experiences of busy ICU clinicians, the work of an ICU clinical psychologist, and some supportive strategies different institutions have used during the pandemic. Here you’ll listen to the valuable thoughts and considerations about topics including personal wellbeing, awareness of mindset, effects on healthcare workers as a group and even some possible gains from the pandemic hardship. In this sixth episode of the “Persevering Through A Pandemic” series, the guests (in order of appearance) are Dr Rana Awdish, Dr Hayley Gershengorn, Dr Laura Rock, Dr Wes Ely, CCRN Simone Hannah-Clark, Dr Peter Brindley, Dr Matt Morgan, Dr Hugh Montgomery, Dr Georg Auzinger and Dr Julie Highfield. I firmly believe that ICU clinicians across the world need to spend time reflecting, processing or simply healing from this pandemic. Reinvigorating ourselves from the difficulties we’ve suffered and restoring ourselves for whatever is to come. My hope is this episode will help you to do this. Thank you for listening to these wise and thoughtful Intensive Care clinicians speak about how they’ve been “Persevering Through A Pandemic”.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower Intensive Care clinicians through conversations about the human side of Intensive Care to bring their best selves to work by focusing on compassion, collaboration and personal wellbeing.   -------------------- Links to featured guests (in order of appearance) Dr Rana Awdish Dr Rana Awdish on Twitter @RanaAwdish Dr Hayley Gershengorn Dr Hayley Gershengorn on Twitter @HBGMD Dr Laura Rock Dr Laura Rock on Twitter @drlaurarock Dr Wes Ely Dr Wes Ely on Twitter @WesElyMD CCRN Simone Hannah-Clark CCRN Simone Hannah-Clark on Twitter @kiwi_yankee Dr Peter Brindley Dr Peter Brindley on Twitter @docpgb Dr Matthew Morgan Dr Matthew Morgan on Twitter @dr_mattmorgan Dr Hugh Montgomery Dr Hugh Montgomery on Twitter @hugh_montgomery Dr Georg Auzinger Dr Julie Highfield Dr Julie Highfield on Twitter @DrJulie_H   Links to other resources (in order of mentioning) Book "Every Deep-Drawn Breath" (by Wes Ely)   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 15 with Peter Brindley Mastering Intensive Care podcast - Episode 33 with Wes Ely Mastering Intensive Care podcast - Episode 36 with Hayley Gershengorn Mastering Intensive Care podcast - Episode 41 with Rana Awdish Mastering Intensive Care podcast - Episode 47 with Matt Morgan Mastering Intensive Care podcast - Episode 48 with Laura Rock Mastering Intensive Care podcast - Episode 49 with Hugh Montgomery Mastering Intensive Care podcast - Episode 57 with Georg Auzinger Mastering Intensive Care podcast - Episode 60 with Simone Hannah-Clark 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Intensive Care clinicians are used to being busy. Critically ill patients constantly arrive in the ICU with no awareness of staff workload at that moment. So being busy has not been the major problem of the COVID-19 pandemic. The difficult emotional responses to physical exhaustion, mental strain, heart-breaking human loss and the unpredictability of SARS-CoV-2 have been significant, and the commonly held attitude of “just power through” has not been sustainable. Instead, the most critical influence on the overall wellbeing of Intensive Care practitioners has been the degree to which they have felt supported socially. Maintaining social support and cohesion is hard. Intensive Care professionals have often depended on social support through camaraderie and workplace culture yet have been crying out during this healthcare crisis to hospital administrators, often in vain, for direct and valuable supportive measures for staff wellbeing. The pandemic has therefore required a more healing and individual-focused type of supportive strategy. Coming up with successful strategies is not easy and a specific strategy will not support all individuals in all contexts. So, ICU teams have had to try a mixture of strategies, philosophies, support groups, or simply caring attitudes to provide effective staff wellbeing support. In this fifth episode of the “Persevering Through A Pandemic” series, you’ll hear some of the types of supportive actions that my guests in this series have witnessed in their ICUs and hospitals. My guests on the episode (in order of appearance) are Dr Hugh Montgomery, Dr Rana Awdish, CCRN Simone Hannah-Clark, Dr Hayley Gershengorn, Dr Laura Rock, Dr Matt Morgan, Dr Peter Brindley, Dr Wes Ely and Dr Georg Auzinger. There is so much we can learn from the COVID-19 pandemic. My hope is this episode will help you as a listener to reflect on and to process your own pandemic experience whilst hearing lessons you might take away to your Intensive Care community. Thank you for listening to these wise and thoughtful Intensive Care clinicians tell you how they’ve been “Persevering Through A Pandemic”.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower Intensive Care clinicians through conversations about the human side of Intensive Care to bring their best selves to work by focusing on compassion, collaboration and personal wellbeing.   -------------------- Links to featured guests (in order of appearance) Dr Hugh Montgomery Dr Hugh Montgomery on Twitter @hugh_montgomery Dr Rana Awdish Dr Rana Awdish on Twitter @RanaAwdish CCRN Simone Hannah-Clark CCRN Simone Hannah-Clark on Twitter @kiwi_yankee Dr Hayley Gershengorn Dr Hayley Gershengorn on Twitter @HBGMD Dr Laura Rock Dr Laura Rock on Twitter @drlaurarock Dr Matthew Morgan Dr Matthew Morgan on Twitter @dr_mattmorgan Dr Peter Brindley Dr Peter Brindley on Twitter @docpgb Dr Wes Ely Dr Wes Ely on Twitter @WesElyMD Dr Georg Auzinger   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 15 with Peter Brindley Mastering Intensive Care podcast - Episode 33 with Wes Ely Mastering Intensive Care podcast - Episode 36 with Hayley Gershengorn Mastering Intensive Care podcast - Episode 41 with Rana Awdish Mastering Intensive Care podcast - Episode 47 with Matt Morgan Mastering Intensive Care podcast - Episode 48 with Laura Rock Mastering Intensive Care podcast - Episode 49 with Hugh Montgomery Mastering Intensive Care podcast - Episode 57 with Georg Auzinger Mastering Intensive Care podcast - Episode 60 with Simone Hannah-Clark 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

The physical, mental and emotional burden of the COVID-19 pandemic on Intensive Care clinicians has been colossal. Many ICU staff, of all types and at all levels, have suffered significant psychological effects. After hearing the pandemic experiences and perspectives of bedside clinicians in recent episodes, the focus of today’s episode is a clinical psychologist who’s been working inside several busy ICUs and supported hundreds of people across the United Kingdom during the pandemic. In this fourth episode of the “Persevering Through A Pandemic” series, you’ll hear the thoughts of Dr Julie Highfield who has led a national UK-based wellbeing program in response to COVID-19. Dr Highfield works as a consultant clinical psychologist in several ICUs in Wales and has an additional role as the National Wellbeing Director for the Intensive Care Society in the UK. In this episode Julie talks about: The first year of the pandemic feeling like the best and worst year of her life Her witnessing of ICU staff “just getting on with it” and “shelving their feelings” The types of support she provided – in both her local ICUs and across the UK Which support worked best for which staff The value of one-on-one sessions - yet their impracticality in a pandemic The types of group sessions she led Two typical examples of who Julie has been supporting What surprised her about the ICU teams The rise in the number of UK ICUs with a clinical psychologist The value of having a clinical psychologist embedded in an ICU How Julie fared herself during the height of the pandemic Her thoughts on the restrictions to visitors caused by COVID-19 The lingering effects of this pandemic Advice for people who are considering championing wellbeing in their ICUs.   The culture around wellbeing in our ICUs is slowly changing and the effects of the COVID-19 may accelerate this. A good psychologist is vital to stimulating that change and to providing valuable assistance. My hope is that this episode, as part of a focused series of episodes, will help Intensive Care clinicians to reflect on their own experiences and to learn valuable lessons about psychological aspects of the pandemic. Thank you for listening to the wise and supportive Dr Julie Highfield, an ideal person to share perspectives on how ICU clinicians have been “Persevering Through A Pandemic”.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower Intensive Care clinicians through conversations about the human side of Intensive Care to bring their best selves to work by focusing on compassion, collaboration and personal wellbeing.   --------------------   Links to featured guests Dr Julie Highfield Julie Highfield on Twitter @DrJulie_H Wellbeing Hub at Intensive Care Society website Psychologists In Critical Care UK (PINC-UK)   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Whilst some people choose to run long distances, caring for patients in the ICU is not supposed to feel like an ultramarathon. If you work in the complex, high stress, emotion-generating environment of an ICU, it might sometimes feel like you are the logistics organiser of an ultimate endurance event, but you should hardly feel like you are a competitor. Yet when COVID-19 arrived, the initial sprint became a marathon and that’s now turned into a seemingly never-ending ultramarathon. In this third episode of the “Persevering Through A Pandemic” series, you’ll hear about this pandemic ultramarathon and the effects it’s had on the people working in ICUs in the UK. A period which has been physically and emotionally difficult yet has provided glimpses of career satisfaction along the journey. Amongst other topics, UK intensivists Drs Matt Morgan, Hugh Montgomery & Georg Auzinger talk honestly about their worst pandemic days, the discomfort that they and their colleagues felt, how their teams kept afloat in such an overwhelming situation and the lingering effects on clinician mental health. There is mention of an interesting letter one of them sent and a special kind of chocolate cake! My hope is this will help you as a listener to reflect on and to process your own pandemic experience whilst hearing lessons you might take away to your Intensive Care community. Thank you for listening to these wise and thoughtful Intensive Care clinicians tell you how they’ve been “Persevering Through A Pandemic”.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower Intensive Care clinicians through conversations about the human side of Intensive Care to bring their best selves to work by focusing on compassion, collaboration and personal wellbeing.   --------------------   Links to featured guests Dr Matthew Morgan Matt Morgan on Twitter @dr_mattmorgan Book "Critical" (by Matt Morgan) Matt Morgan – Previous episode on Mastering Intensive Care Dr Hugh Montgomery Hugh Montgomery on Twitter @hugh_montgomery Hugh Montgomery – Previous episode on Mastering Intensive Care Dr Georg Auzinger Georg Auzinger – Previous episode on Mastering Intensive Care   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Just like a surf beach shore, waves of COVID-19 keep crashing over the world’s Intensive Care Units. The waves have been unpredictable and pattern less, ravaging the ICUs and the people that work in them, often inconceivably. In this second episode of the “Persevering Through A Pandemic” series, you’ll hear from Intensive Care professionals about the COVID-19 pandemic which continues to affect ICUs across the globe. Amongst other topics, US intensivists Drs Rana Awdish & Dr Hayley Gershengorn, and Critical Care nurse Simone Hannah-Clark talk honestly about their worst pandemic days, the feelings of guilt, fear, anxiety and overall depletion, the effects on their family, what they witnessed in their struggling colleagues and how they dealt with the strain. You’ll also hear valuable thoughts on the nursing perspective, the difficult experience of being a patient in a pandemic, and the tension between the support from the community and the flagrant COVID-19 deniers. There have been many emotional and heart-breaking conversations in ICUs all over the world during this pandemic. And we as their healthcare providers have emotions to express too. My belief is that we need to have conversations as colleagues, and as an Intensive Care community, about what we have been and are continuing to go through. My hope is that this series will help you as a listener to reflect on and to process your own pandemic experience whilst hearing lessons you might take away to your Intensive Care community. Thank you for listening to these wise and thoughtful Intensive Care clinicians tell you how they’ve been “Persevering Through A Pandemic”.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower Intensive Care clinicians through conversations about the human side of Intensive Care to bring their best selves to work by focusing on compassion, collaboration and personal wellbeing.   --------------------   Links to featured guests Dr Rana Awdish Rana Awdish on Twitter @RanaAwdish Book "In Shock" (by Rana Awdish) Rana Awdish – Previous episode on Mastering Intensive Care Dr Hayley Gershengorn Hayley Gershengorn on Twitter @HBGMD Hayley Gershengorn – Previous episode on Mastering Intensive Care CCRN Simone Hannah-Clark Simone Hannah-Clark on Twitter @kiwi_yankee Simone Hannah-Clark – Previous episode on Mastering Intensive Care   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Are you sick of COVID? How have you coped in this pandemic? And what’s it actually felt like to live and work throughout this last two years?   Concerned for the wellbeing of healthcare professionals in the hardest hit ICUs during the COVID-19 pandemic, I interviewed a group of clinicians previously featured on the podcast. With an emphasis on personal wellbeing, I aimed to uncover their feelings, their struggles, their perspectives and their take-aways from this prolonged global healthcare crisis. My hope is to help you to reflect on and to process your own pandemic experience and to hear lessons you might take away to your Intensive Care community. In this first episode of a series focusing on Intensive Care clinician wellbeing during the pandemic, you’ll hear the voices of Dr Laura Rock, Dr Peter Brindley and Dr Wes Ely. Thank you for listening to these wise and thoughtful Intensive Care clinicians tell you how they’ve been “Persevering Through A Pandemic”.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower Intensive Care clinicians through conversations about the human side of Intensive Care to bring their best selves to work by focusing on compassion, collaboration and personal wellbeing.   --------------------   Links to featured guests Dr Laura Rock Dr Laura Rock on Twitter @drlaurarock Dr Laura Rock – Previous episode on Mastering Intensive Care Dr Peter Brindley Dr Peter Brindley on Twitter @docpgb Dr Peter Brindley – Previous episode on Mastering Intensive Care Dr Wes Ely Dr Wes Ely on Twitter @WesElyMD Book "Every Deep-Drawn Breath" (by Wes Ely) Dr Wes Ely – Previous episode on Mastering Intensive Care   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

I’m trying something different on Mastering Intensive Care. Welcome to a special series named “Persevering Through A Pandemic”. Aghast at the stories I’d heard from Intensive Care colleagues amid large COVID-19 surges I approached several previous podcast guests in countries that had been harder hit than Australia. Concerned for their wellbeing I asked if they’d talk to me about what they’d been going through to help me understand how the health professionals in the busiest ICUs had been coping. They willingly shared their stories and reflections on many aspects of their experience. Their feelings, their struggles, their teammates, their learnings, their take-aways. The COVID-19 pandemic is far from over. Please listen in over the next 6 weekly episodes as a group of wise and thoughtful Intensive Care clinicians tell you how they have been "Persevering Through A Pandemic".   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower Intensive Care clinicians through conversations about the human side of Intensive Care to bring their best selves to work by focusing on compassion, collaboration and personal wellbeing.

Mastering Intensive Care is back after a lengthy break with an episode featuring senior ICU dietitian Dr Emma Ridley. Emma is a Senior Research Fellow and a NHMRC Emerging Leadership Fellow at the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) at Monash University in Melbourne, where she leads the Nutrition Program. Emma has 16 years of clinical dietetic experience, including as a senior dietitian in the ICU at The Alfred Hospital in Melbourne, and over 13 years of research experience, including the awarding of her PhD. Her research interests include energy requirements across the hospitalisation period, the clinical application of indirect calorimetry and the effect of optimal nutrition delivery on short and long-term outcomes in ICU patients. Emma is a long-time colleague of mine, someone I have huge respect for, and a woman that seems to fit a lot into a busy life and career. I was keen to talk to Emma for the podcast so I could ask about topics such as how she sees dietitians best fitting into the ICU team, what her thoughts are on communication between different ICU staff roles and what is required for a dietitian to be a valuable advocate for ICU patient nutrition. Emma also has some important insights from the difficult experience of having her recently newborn son admitted to the NICU. This episode is not just for dietitians. Emma is such a wise and thoughtful healthcare leader that there are pertinent perspectives in this conversation that will help doctors, nurses and practitioners in any Intensive Care role. The list of topics Emma discussed include: How she became a dietitian in Intensive Care Her reflections on the pace of an ICU The importance of dietitians and doctors understanding each others “language” How she feels dietitians best fit into the ICU team Advocating for ICU patient nutrition at the bedside The importance of dietitians being present at the ICU ward round Working with the different members of the ICU team Optimal communication between colleagues The importance of getting to know your colleagues Talking to patients and their families Why she was fascinated by research and how this has helped her clinical practice Why she feels research allows her to have a greater impact The benefits of embedding nutrition research in an ICU Her interest in nutrition at the time when ICU patients are transitioning out of the ICU The differences between leadership, mentorship and sponsorship The effects of the pandemic on her role Her work to assist nutrition for critically ill patients with COVID Managing personal safety and wellbeing during the pandemic The experience of her newborn son being admitted to the NICU Fitting everything in to a busy life The value of work flexibility and how this affects her clinical work capacity Her closing advice to less experienced ICU practitioners   Thanks for listening to my conversation with Emma Ridley.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the work, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Emma Ridley Dr Emma Ridley at ANZIC RC Emma Ridley on Twitter @ICUnutrition ANZIC Research Centre   Links to other resources (in order of mentioning) ANZICS Clinical Trials Group Mastering Intensive Care podcast - Episode 5 with Jamie Cooper Guideline for Nutritional Management of COVID patients Media and Medicine Program at Harvard Medical School 
 Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This episode features Professor David Tuxen, a pioneer of Intensive Care in Australia, who recently retired after 38 years at the Alfred Hospital in Melbourne. David trained in both respiratory and intensive care medicine, and became the Alfred’s ICU Director at a young age. He led the development of one of Australia’s first mega-ICUs before standing down after over 20 years as Director to re-energise his passion for teaching and research. David is a Professor at Monash University, still works as an intensivist at Albury Hospital and previously served in leadership roles including President of ANZICS and Chairman of the Australian and New Zealand Intensive Care Foundation. He is globally renowned for his teaching and research on many aspects of mechanical ventilation. David was my first ICU Director, and he rapidly became, and remains, a wise, enthusiastic and long-standing mentor to me. I have particularly admired his excellent clinical skills and specifically his attention to detail so I am thrilled he agreed to appear on the podcast. Given many people in Australia and New Zealand know David by his nickname “Tux” it shouldn’t surprise you to know that David likes to have fun and bring humour to most occasions. In this episode, David’s principle message is not to be serious at all times during a day at work, and to keep up an active social life, including with colleagues, in the periods between work. David delivers a lot of other great advice in this episode, as he talks about topics including: Becoming an ICU Director at a young age The changes he’s witnessed over his career Which patients we sometimes over-treat in our ICUs Resolving differing opinions about patient prognoses The value of thorough physical examination in ICU Building rapport with families, especially for end of life conversations His experience in being filmed for a reality TV series Communicating with patient’s families Ward round teaching Tips for presenting a good talk The differences between working in a tertiary and a regional centre ICU What he thinks best maintains his wellbeing The toll of work on his family life   Tux has led a high-achieving, well-respected and clinically-orientated career. It’s a great privilege to have him on the podcast. I hope you will enjoy listening to David Tuxen.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to this episode David Tuxen on Twitter @TuxenDavid Audio of talk by David Tuxen on the history of the Alfred ICU Australian and New Zealand Intensive Care Society (ANZICS) Australian and New Zealand Intensive Care Foundation 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In this episode the focus is on our Intensive Care friends in the UK and what they are going through right now with COVID-19. My guest is Rupert Pearse, a Professor and Consultant in Intensive Care Medicine at Barts Health NHS Trust and Queen Mary University of London. He works at the Royal London Hospital, which was at the epicentre of the first wave and now the second COVID wave in East London. Rupert's recent work on Twitter through public health messaging has been outstanding and you can follow him @Rupert_Pearse. Despite being terribly busy in London, Rupert willingly gave his time to talk about: How the cases of COVID-19 are tracking right now How the logistical challenge is being gradually replaced by important reflection What the Royal London Hospital ICU did to deal with the surge The ongoing research they’ve been doing during the pandemic Why the Nightingale hospitals of the first wave seemed to struggle The stress and strain associated with diluting the nurse to patient ratio The difficulty with blending leadership structures during an intense period How they have maintained their ICU culture The struggle of his colleagues caring for themselves as healthcare professionals His advice to less affected areas of the world Why he changed his approach to delivering public health messages for the second wave The principles he follows when speaking to the media How he describes this period of his career.   I hope you will find value from listening to Rupert Pearse.   Andrew Davies   -------------------- About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Rupert Pearse Rupert Pearse Rupert Pearse on Twitter @rupert_pearse Royal London Hospital   Links to other resources (in order of mentioning) Twitter prose posted by Rupert Pearse Recovery trial REMAP-CAP trial   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This wide-ranging episode, covering many angles of how we should consider doing less interventions to our patients and more transparent communication to their families, features US intensivist Todd Rice. Dr Todd Rice, is an Associate Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. Todd is a clinical intensivist, the Director of the Medical ICU (MICU) and the Medical ECMO Program, and leads VUMC’s MICU strategy for the care of COVID-19 patients. In addition, Todd leads a substantial research program as a clinician scientist, and is co-chair of the Learning Healthcare System at Vanderbilt where the motto is "Learn What We Do and Do What We Learn." Professionally, he is proud of the evidence he has generated to improve the care of critically ill patients and the mentorship he has provided to other physician scientists. He loves ice hockey (watching, not playing) and is completely into enjoying life with his two sons. Todd graduated from the University of Notre Dame and completed Internal Medicine residency at Indiana University School of Medicine. He completed Pulmonary and Critical Care Medicine fellowship training at Vanderbilt University where he obtained a Master’s of Science in Clinical Investigation. Other roles Todd serves in include: President of the American Society of Parenteral and Enteral Nutrition Vice President for Clinical Trial Innovation and Operations in the Vanderbilt Institute for Clinical and Translational Research (VICTR) Critical care principal investigator for the Prevention and Early Treatment of Acute Lung injury (PETAL) clinical center at VUMC Medical Director of VUMC’s Human Research Protections Program Todd and I recorded this conversation in March 2020, just before the COVID-19 impacted fully in our respective countries. I didn’t feel I should put this episode out during the crisis of 2020 so I held it back until now. I also asked Todd if I could interview him a second time now (in February 2021) to freshen up the interview with some perspectives on how COVID-19 has affected he and his colleagues in Nashville. I hope you will gain immense value from what Todd speaks about on this episode, including: Why he’s considered an ICU junkie and how he’s changed over the years The principle of “Don’t just do something, stand there” Understanding the confidence/competence balance His 4 box method of understanding a critically ill patient’s situation The concept of the second victim with mistakes How transparency to families builds substantial trust Why he praises nurses in front of patient’s families The structure of the ward round at his ICU The importance of empowering nurses to ask questions His note-writing practice, and it’s benefits and risks His practice to look after himself during periods of clinical service The benefit of a mix of clinical and research work The importance of pragmatic trials studying things we are already doing His institution’s Learning Healthcare System and how it is used Some overall career tips How COVID-19 has affected his ICU How the ICU team is taking care of each other His ICUs struggle with harsh visitor restrictions and how they relaxed these safely   Please enjoy listening to Todd Rice.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Todd Rice Todd Rice Todd Rice on Twitter @toddrice_icu   Links to other resources (in order of mentioning) ANZICS Clinical Trials Group ARDSnet low tidal volume strategy study EDEN study TARGET study PERMIT study   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This first podcast episode of 2021 is my attempt to put into perspective at least some of what has happened over the whirlwind of the last 12 months. We can’t control what happens to us, yet we can control our actions in response to our circumstances and we can learn from our experience. I feel like the whole experience of COVID has delivered a few important lessons for us as an Intensive Care community, so in this episode you’ll hear 5 valuable lessons I have been reflecting on. In line with the theme of the podcast, I’ll concentrate on what Intensive Care has learnt, rather than humanity in general. And although 2020 involved much discussion about various drugs, ventilator settings and other interventions, my curiosity is the human side of things. I’ll therefore concentrate on how the novel coronavirus has affected us - as individual healthcare practitioners, as distinct ICUs, and as a greater intensive care community. I am aware many of you are still struggling with overwhelming situations where you work and I understand there is still much more pandemic in front of us all. In the meantime, I hope you will take some solace from listening as I take you through the biggest lessons I feel COVID-19 has taught us in Intensive Care. None are unique to my thinking. None are rocket science. They are simply worth speaking about if only so you might reflect on what I’ve noticed from my own 2020 professional experience as we move into the next part of this pandemic and eventually beyond it. I hope you’ll listen to the podcast to hear the 5 lessons in full. They relate to: The human resources our ICUs contain The general community’s perception of Intensive Care The downside of harsh visitor restrictions Healthcare worker safety, and The future of Intensive Care education You have likely reflected on other lessons. Please let me hear them. I’d also love to receive any feedback or comments you have. If you use Twitter, include my handle @andrewdavies66 and/or #masteringintensivecare. Or simply email me at [email protected]. I invite you to listen to the 5 valuable lessons COVID-19 taught Intensive Care in 2020.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing. -------------------- Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 60 with Simone Hannah-Clark Mastering Intensive Care podcast - Episode 64 with Roger Harris & Oli Flower 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Two inspiring and innovative educationalists, Dr Roger Harris and Dr Oliver Flower, are featured in this episode. Both of these Sydney intensivists are the force behind the recently created educational initiative named Coda, having previously been two members of the successful triumvirate who set up SMACC (Social Media and Critical Care). To my mind Oliver (or Oli) and Roger have led an educational revolution by utilising speakers with high level presentation skills and encouraging community engagement, through a blend of real life events, internet technology and social media, to bring us the type of innovative and entertaining educational platform we haven’t previously seen in intensive or critical care. Dr Roger Harris is a senior staff specialist in the ICU at the Royal North Shore hospital and the Sydney Adventist hospital. He is dual qualified in Emergency Medicine and Intensive Care. He is passionate about education, his five children and especially his wife Georgie. He’s on Twitter @RogerRdharris where his bio states he is “privileged to care for the critically ill.” Dr Oli Flower is also an intensivist at the Royal North Shore Hospital in Sydney. He’s steered the creative side of SMACC & Coda, from the graphic design elements to the style, marketing, website and social platform strategies. He has an interest in neurocritical care and is on Twitter @oliflower where his bio states he is a “believer in the power of the big medical community”. We recorded this in February 2020; just before the COVID-19 pandemic scuppered Oli and Roger’s plans to release nearly 4000 tickets to the inaugural large-scale Coda event. Coda is aimed to be more like a festival than a conference and is not only for critical care practitioners but for a wider healthcare audience. The overall goal of Coda is to cover vital broader healthcare subject themes and to assist the assembled community to take meaningful actions as a result of what is discussed, the climate emergency being one of the first of these. When Coda was one of the earlier healthcare conferences to be postponed in the pandemic, I also held this podcast back until there could be firmer plans about any live Coda events. A meeting named Coda Zero Live has now been announced for 16-18 February 2021. This is an event in Sydney with both a live and a virtual audience. It now seemed appropriate to release this episode to help you know about Coda and to encourage you to attend or tune in to Coda Zero Live. This interview is well worth listening to as, despite no mention of COVID-19, you’ll hear: The career backgrounds of Oli and Roger Roger's humility in training in a second speciality in the same hospital Both of their views on the mature culture and flattened hierarchy in their ICU at Royal North Shore Hospital Perspectives on gender equity as well as diversity and inclusion in an Intensive Care department The story behind the educational initiatives of SMACC and Coda The marginalisation of non-technical topics they noticed in most scientific meetings The growing appetite they were observing for these same topics The value of delegate feedback in directing educational initiatives How SMACC developed such an engaged community The vision for Coda including its initial themes of education, ethics, earth and cure The plans for tackling the climate emergency as a healthcare practitioner community Discussion about how a plant-rich diet is beneficial for both environmental and personal health What Oli and Roger have learnt from all these educational pursuits to help them at the bedside How they both stay balanced Some tips for less experienced clinicians   Please enjoy listening to Roger Harris & Oli Flower.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Roger Harris and Oli Flower Roger Harris Roger Harris on Twitter @RogerRdharris Oli Flower Oli Flower on Twitter @OliFlower Intensive Care Unit at Royal North Shore Hospital Coda Coda on Twitter Coda Zero Live Event - 16-18 February 2021 Intensive Care Network Intensive Care Network podcasts   Links to other resources (in order of mentioning) Chris Nickson SMACC Coda Coda Zero Live Queen Square Sydney HEMS Staff at Royal North Shore Hospital ICU Australasian Trauma Society Australasian College of Emergency Medicine College of Intensive Care Medicine SMACC Berlin Final Day Program Martin Bromiley Life In The Fast Lane Blog Intensive Care Network Simon Carley St Emlyn’s Scott Weingart EMCrit Haney Mallemat Ken Milne SMACC Conference History ANZICS SCCM Rob MacSweeney Critical Care Reviews Conference Jesse Spurr Mary Freer New England Journal of Medicine John Hinds Coda Zero Episode 1: Cure - Pandemic Sepsis Coda Zero Episode 2: Ethics - Gender Video Coda Zero Episode 3: Educate - Communicating in the era of big data, AI and the “infodemic” Coda Zero Episode 4: Earth - A safe and healthy pandemic recovery Coda Zero Live Event - 16-18 February 2021 Safe Airway Society   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 21 with Martin Bromiley Mastering Intensive Care podcast - Episode 28 with Simon Finfer Mastering Intensive Care podcast - Episode 45 with Scott Weingart 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

The guest on this episode is Nurse Practitioner Naomi Pratt who describes the lingering and harrowing effects of long COVID. Naomi is a Nurse Practitioner who jointly manages and leads the Critical Care Liaison Nurse service at Peninsula Health. In this role she provides clinical leadership and the Intensive Care response to Medical Emergency Team calls. She has completed post graduate qualifications in Intensive Care and has over 20 years of ICU experience. She completed her Masters in Nursing (Nurse Practitioner) at LaTrobe University and has been an endorsed Nurse Practitioner since 2015. Naomi has a keen interest in providing critical care outreach and supporting clinicians caring for deteriorating patients in ward areas outside of ICU. She is a clinical mentor for advanced practice nurses at Peninsula Health and has undertaken research to understand the factors associated with the care of deteriorating patients. This has resulted in several conference presentations and journal publications. Naomi tries to balance the challenge of work and enjoying time with her family and friends. She is lucky to live on the Mornington Peninsula, outside of Melbourne, where she shares the environment with many local animals including the visiting koalas, birdlife and pobblebonk frogs. Naomi and I work at the same hospital and I started wondering if something was wrong when I hadn’t seen her for over a month during the first wave of the COVID-19 pandemic. Sure enough, Naomi was at home and was unwell with COVID-19. Naomi has experienced a diverse range of significant symptoms over many months, some of which have lingered. She has resumed working with lighter duties than her usual busy role, yet experiences “up and down” periods with a decent level of fatigue. Naomi remains below her normal full health and seems to now have the condition which has become known as long COVID. Naomi is a true expert at keeping sick hospitalised patients out of ICU and, whilst performing that role, appears to have developed COVID-19 from exposure to a patient. I therefore asked her if we could record a conversation about her 2020 experience so it might help others. In this episode, Naomi talks about: Her career background to becoming a Critical Care Liaison Nurse The role she plays in the Liaison Nurse service at Frankston Hospital How she juggles the many different requirements of this position The night shift she was exposed to COVID-19 by helping to intubate a patient The PPE policy at that early period of the pandemic Developing the symptoms of, and being diagnosed with, COVID-19 Why she felt she shouldn’t share this information with other people early in her illness Her personal health experience of COVID-19 Quarantining in her home with her family The severe chest pains she later endured The many additional symptoms she developed as it turned into long COVID How she is feeling now, many months later, in her recovery Some thoughts about keeping healthcare workers safe from COVID-19   Naomi is courageous to tell her personal health story on a podcast. I really hope you find this valuable to listen to.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Naomi Pratt Naomi Pratt at Peninsula Health Naomi Pratt on Twitter: @gnome3927   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

This episode is a departure from recent conversations about COVID-19 material to cover some very important topics on the human side of what we do in the ICU. My hope is you will glean valuable insights from an intensivist I admire greatly as both an expert practitioner and an esteemed educator of high-level intensive care communication - amongst other things, of course. Dr Steve Philpot is an Intensive Care Specialist at Cabrini Hospital in Melbourne with a special interest in end of life care, organ and tissue donation, communication skills training and empathy in the workplace. He is the National Lead Trainer for the DonateLife Family Donation Conversation Workshops, the Convenor of the College of Intensive Care Medicine communication training program, convenor of the Cabrini Health “Shared Decision Making” and “Advance Care Planning Conversations” workshops and chair of the Cabrini Health End of Life Care Committee. Steve is an Adjunct Senior Lecturer at Monash University and is involved in undergraduate communication training. He is currently completing a Masters of Health and Medical Law at Melbourne University. His other interests include playing guitar, singing, walking his dogs, the Fremantle Football Club (in the Australian Football League), and writing. Steve was once an advanced trainee where I worked as a consultant, and always displayed wisdom beyond his experience, something that comes through in this conversation, even if he is highly experienced now. We recorded this conversation before SARS-COV2 had been described, so there is no discussion of the COVID-19 pandemic, but I guess that makes it a favourable choice to listen to for many of you right now. In this conversation, Steve talks on topics including: The importance of being calm and collaborative His realisation that knowledge is not the most important thing we need The usefulness in giving positive feedback, and being helpful, kind and humble How tribalism damages workplace culture, and how we can deal with this The ways he builds relationships with other team members 3 vital points about, and his number 1 tip for communication The usefulness of having an evolving phrase library Shared decision making, including asking vital questions to learn what a patient really wants His outside work interests, and what his self-care practice is Thoughts on making a transition from a mega ICU to a smaller ICU, and The value of knowing you already know enough   Steve uses story-telling very powerfully in this episode. Please enjoy listening to Dr Steve Philpot.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you to bring your best self to the Intensive Care bedside, through conversations about the human side of what we do, so you can be the most kind, compassionate and effective healthcare practitioner you can be.   --------------------   Links related to Steve Philpot Steve Philpot at Cabrini Health Intensive Care Unit Steve Philpot on LinkedIn Donate Life Family Donation Conversation Workshops (Steve is National Lead Trainer) Article by Steve Philpot on Shared Decision Making   Links to other resources (in order of mentioning) Study on Tribalism CICM Communication Course Article by Steve Philpot on Shared Decision Making Podcast “Dolly Parton’s America” Podcast “13 Minutes To The Moon” Podcast “This American Life” Podcast “Hamish & Andy” Author Jane Harper Book “Sapiens” (by Yuval Noah Harari)   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

2020 has been a roller coaster year and I wish to acknowledge my friends of the Intensive Care world for your outstanding and awe-inspiring efforts as clinicians, researchers, educators, digital content creators, and mostly as human beings, compassionately caring for others in a truly unprecedented global crisis. COVID-19 is far from over yet. Massive numbers of cases are still being reported each day and many countries are re-instituting public health-focused social and business restrictions. So whilst the pandemic continues, unabated, it feels like the right time to reinvigorate the Mastering Intensive Care podcast, after a 6 month break, with an episode where I express my gratitude to each of you individually, thanking you for what you have done so far, and for what you will likely need to continue to do. This isn’t a thank you to one discipline of people who work in the ICU. It’s to every single person, in every role, who has supported either the people admitted to or those who work in any ICU in the world. We need to look after each other as the pandemic is not going away. The promise of a vaccine is really only that. And many of you have done it tough either through the gruelling and onerous work or through the exhausting fatigue, whether that be physical, mental or emotional, you’ve suffered. There have been many patients with COVID-19 admitted to ICUs, there have been many deaths, and sadly there have been many healthcare worker deaths, including Intensive Care professionals. My heart goes out to those who have died, their families and especially you as their colleagues. It has been one of the hardest things you have all had to deal with. The emotional turmoil, let alone the physical toil, many of you have been under has been extreme. And all I can hope for is that things settle down very soon. Thank you and well done. You are true heroes. Please listen to my tribute to the awesome and astonishing Intensive Care community of the world.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The show focuses on the human aspects of what happens at the Intensive Care Unit bedside. The aim is to inspire and support you to bring your best self to work as well as to be the most kind, compassionate and effective Intensive Care professional you can.   --------------------   Links to recent COVID-19 podcasts on Mastering Intensive Care Steve McGloughlin - Preparing for the COVID-19 pandemic (MIC #59) Firsthand COVID-19 patient experience from New York ICU nurse Simone Hannah-Clark (MIC #60)   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In many parts of the world the COVID-19 pandemic is overburdening Intensive Care Units with huge numbers of critically unwell patients, many of whom are dying. Whilst China, Italy, Spain, France, Germany and the UK have been crisis-ridden over the last few months, one of the most inundated parts of the world right now is the USA and especially the state of New York. In this episode you will hear the firsthand experience of a New York City ICU nurse where things are extremely intense and overwhelming. Simone Hannah-Clark is a critical care nurse in the Medical ICU at the Mount Sinai hospital in Manhattan. Originally a New Zealander, she worked in both New Zealand and Australia before moving to the USA 15 years ago. Simone recently penned an engrossing New York Times opinion piece entitled “An ICU Nurse’s Coronavirus Diary”. In this podcast she delves deeper into her recent reality as a nurse caring for ICU patients with COVID-19. She recounts stories of the hard work, the sense of duty, the intricacies of personal protective equipment, the inspiring camaraderie, her revived passion for her job, and above all the heartbreaking emotion of dying patients with absent relatives. Nurses around the globe are doing extremely arduous jobs and risking their own health as they care for thousands of seriously ill people with COVID-19. They are the true linchpins of the ICU. As you’ll glean in this episode, Simone is a perfect example of the compassion, professionalism and humanity that is so essential in the world right now. Thanks for listening to this conversation with Simone Hannah-Clark.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The show aims to focus on the human aspects of what happens at the Intensive Care Unit bedside. Conversations with thought-provoking guests should hopefully help you to bring your best self to work as an intensive care clinician.   --------------------   Links related to Simone Hannah-Clark Simone Hannah-Clark on Twitter Opinion piece in New York Times “An ICU Nurse’s Coronavirus Diary” (by Simone Hannah-Clark)   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In the midst of the global COVID-19 pandemic, this episode focuses on the pandemic planning all ICUs should be doing - if they haven’t already been overwhelmed. This week a Working Group of 30 colleagues released the Australian and New Zealand Intensive Care Society (ANZICS) COVID-19 Guidelines. This episode features the Chair of that Working Group, A/Prof Steve McGloughlin. Steve is an intensivist, an infectious diseases physician, and the Director of the ICU at the Alfred Hospital in Melbourne, one of the largest Australian ICUs. In this conversation, Steve talks about: How he is “hoping for the best and preparing for the worst” His confidence in the Australian Intensive Care system How and why the ANZICS COVID-19 Guidelines were developed Measures for increasing ICU capacity His belief that intensive care can be offered to all who might benefit in the pandemic The need to communicate more in a crisis to ease anxiety The value of asking “Are you confident we know what we are doing as a team”? PPE being safe as long as the equipment is used properly His ICU developing the role of a PPE monitor The hierarchy for negative pressure room use Splitting teams into 3 so workers are either on, on call, or totally off What the guidelines recommend about high flow nasal oxygen, non-invasive ventilation & ECMO The lack of evidence for medications and COVID-19 Looking after our teams by ensuring a degree of confidence How he will deal with the social isolation The ways we might obtain additional intensive care trained healthcare workers His thoughts on older health care workers and their risks If you are in a place where the number of COVID-19 patients are ramping up, I really think this is a must listen episode.   We are all in this together.   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Steve McGloughlin A/Prof Steve McGloughlin A/Prof Steve McGloughlin on LinkedIn Alfred Intensive Care Unit   Links to resources (in order of mentioning) WHO situation reports on COVID-19 ANZICS COVID-19 guidelines (Version 1) ANZICS JAMA Network Video “Coronavirus in Italy - Reports From The Front Lines”   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 47 with Matt Morgan Mastering Intensive Care podcast - Episode 58 on "COVID-19 - We are all in this together" 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Our need to bring our best selves to work has become more important in the face of this COVID-19 pandemic sweeping the globe. Many intensive care clinicians are presently overwhelmed by escalating numbers of critically ill COVID-19 patients whilst many others are carefully preparing for seemingly inevitable local outbreaks. There is an eerie feeling where I live and work in Melbourne especially with the online reports and accounts from our heroic colleagues in harder hit places like China, Italy and even parts of the USA. My wife, Claire Davies, and I thought it would be useful to record a conversation about what’s going through our minds, right now in mid-March 2020, as public health officials and healthcare organisations around the world are either managing or preparing for the onslaught of individuals infected with the virus whilst also enacting public health measures such as social distancing and airline travel restrictions. Claire, who was a previous interview guest on episode 29, spent almost 2 decades as an intensive care nurse before retraining in pastoral care and now works in that role at Epworth Hospital in Melbourne. Claire and I fully recognise that colleagues in some parts of the world have significantly more experience with the novel Corona virus than we do but if, like us, you are thinking a lot about this pandemic and fearful of what is about to happen I hope you find some value in this conversation between Claire and I. In it we talk about: Our gratitude for those clinicians working in the overwhelmed areas Claire’s hope they know they are not alone Claire’s own current fears and how this has manifest Balancing the need to manage our fears whilst doing our crucial jobs Claire’s perspective on how we bring our whole selves to work The likely moral distress of making “war time-like” decisions about rationing ventilators The unknowns of providing pastoral/spiritual care in this situation Useful ways to help look after ourselves during the outbreak Recognising that if we don’t transform our personal trauma, we transfer it Trying to eat well, drink less alcohol, sleep well and to get in some exercise Trying to have deep compassion for people making the big decisions The opportunity this pandemic provides to bring us closer together as an intensive care community Being grateful and caring for each other in these times   We are definitely all in this COVID-19 thing together.   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links to resources (in order of mentioning) WHO situation reports on COVID-19 Robcast Podcast episode “I am calling you to talk about the Coronavirus” (by Rob Bell) Book “The Body Keeps The Score” (by Bessel van der Kolk)   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 29 with Claire Davies 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Those of you who are consultant intensivists or attendings hopefully remember most of your trainees - especially the ones you met when you were a brand new intensivist. In this episode I speak with Dr Georg Auzinger who in 1997 moved from Austria to Australia to train in intensive care at the same ICU I was beginning my first job as a specialist intensivist. I have fond memories of working with Georg, have enjoyed the friendship we have developed and have been thrilled to see from afar how well his career has progressed. Nowadays Georg has a senior position in the United Kingdom intensive care field where he is Consultant Honorary Senior Lecturer in Intensive Care Medicine, Lead Clinician at the Liver Intensive Care Unit and Director of the Veno Arterial ECMO service at King’s College Hospital NHS Foundation Trust in London. He is PTEeXAM board certified for perioperative transoesophageal echocardiography and also leads on critical care echocardiography training. Georg has played a substantial role in the outstanding international reputation the Liver Intensive Care Unit at King’s has maintained over the last decade. He is member and associate fellow of the UK Intensive Care Society, as well as member of the European Society of Intensive Care Medicine, the Society of Critical Care Medicine, the Austrian Society of Internal Medicine and the International Liver Transplantation Society. In this conversation, Georg and I do some reminiscing, as we talk about: His transition from doing general medicine in Austria to intensive care in Australia How he found his way to Kings College Hospital in London The changes in the last 2 decades in the types of patients being admitted to ICU The current resource constraints in the UK Working in the Clinical Director role in a busy institution How beneficial colleague performance reviews can be for both parties Relationship building between nurses and doctors Communicating with colleagues The importance of keeping the patient at the centre of what we do The difficulties he recognises in balancing his work and life   Please enjoy listening to Dr Georg Auzinger.   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Georg Auzinger Dr Georg Auzinger at Kings College Kings College Hospital Liver ICU   Links to other resources (in order of mentioning) Prof Julia Wendon Cleveland Clinic London New Normal Project podcast   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 3 with Rinaldo Bellomo Mastering Intensive Care podcast - Episode 12 with Julia Wendon Mastering Intensive Care podcast - Episode 55 with Mervyn Singer Mastering Intensive Care podcast - Episode 56 - What’s in the Journals to help you care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In this episode I talk about what’s been recently published in the medical literature to help you master intensive care from a humanity point of view. In a departure from the usual interview episode, and as a trial, I searched the December 2019 issues of 8 well-respected journals and found a large number of articles focused on non-technical aspects of intensive care. Not the drugs, devices, procedures or interventions, but the person-based and human-focused topics I like to concentrate this podcast on. As I’ve transitioned in my own career from being a researcher of interventions to a producer of a podcast focused on being the best all-round intensive care-givers we can be, I’ve realised there is a growing literature on non-technical topics, some of which I’m not well enough aware of on a day to day basis. So in this episode I found numerous articles from December 2019 which I believe can help you and your colleagues humanise the intensive care you give at the bedside. Some are research studies, some are reviews, and others are stories, essays, poems, or simply writings. I focus in some detail on 3 specific journal articles on the topics of (1) family engagement, (2) family support and (3) early palliative care consultation. I then refer you briefly to 10 other articles so you can read these in full if you are interested. There are links to all of these articles below. I really hope you enjoy and value this episode. I learnt a lot from reading these articles myself. Please send any feedback, questions or comments to [email protected].   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links to 3 Journal articles reviewed in detail Kleinpell R, Zimmerman J, Vermoch KL, et al. Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. Crit Care Med. 2019;47(12):1692–1698. doi:10.1097/CCM.0000000000004009   PubMed link   Associated editorial Lee HW, Park Y, Jang EJ, Lee YJ. Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis [published correction appears in Intensive Care Med. 2019 Oct 8;:]. Intensive Care Med. 2019;45(8):1072–1081. doi:10.1007/s00134-019-05681-3   PubMed link Ma J, Chi S, Buettner B, et al. Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial. Crit Care Med. 2019;47(12):1707–1715. doi:10.1097/CCM.0000000000004016   PubMed link   Links to 10 Journal articles mentioned briefly Barreto BB, Luz M, Rios MNO, Lopes AA, Gusmao-Flores D. The impact of intensive care unit diaries on patients' and relatives' outcomes: a systematic review and meta-analysis. Crit Care. 2019; 23(1):411. Published 2019 Dec 16. doi:10.1186/s13054-019-2678-0   PubMed link Ramchand P. The gift. Lancet. 2020; 394(10216):2283–2284. doi:10.1016/S0140-6736(19)32961-7   PubMed link Harrington JL. The Case for Waking. JAMA. 2019; 322(22):2251. doi:10.1001/jama.2019.17962   PubMed link Maskell G. True candour. BMJ. 2019; 367:l6754. Published 2019 Dec 3. doi:10.1136/bmj.l6754   PubMed link Rimmer A. Bring me joy. BMJ. 2019; 367:l6745. Published 2019 Dec 16. doi:10.1136/bmj.l6745   PubMed link Klaber RE, Bailey S. Kindness: an underrated currency. BMJ. 2019; 367:l6099. Published 2019 Dec 16. doi:10.1136/bmj.l6099   PubMed link Morgan M. Matt Morgan: Cold food on hot desks. BMJ. 2019; 367:l6829. Published 2019 Dec 10. doi:10.1136/bmj.l6829   PubMed link Rimmer A. Suicide in anaesthetists: five minutes with . . . Samantha Shinde. BMJ. 2019;367:l6781. Published 2019 Dec 2. doi:10.1136/bmj.l6781   PubMed link Auriemma CL, Van den Berghe G, Halpern SD. Less is more in critical care is supported by evidence-based medicine. Intensive Care Med. 2019;45(12):1806–1809. doi:10.1007/s00134-019-05771-2   PubMed link Auñón-Chancellor S. Earthling. Ann Intern Med. 2019; 171(12):937–938. doi:10.7326/M19-2759   PubMed link   Links to 8 Journals searched New England Journal of Medicine JAMA: Journal of the American Medical Association BMJ: British Medical Journal The Lancet Annals of Internal Medicine Critical Care Medicine ICM Journal: Intensive Care Medicine American Journal of Respiratory and Critical Care Medicine Critical Care   Links to other resources mentioned Mastering Intensive Care podcast - Episode 3 with Rinaldo Bellomo Critical Care Reviews Link to sign up to Critical Care Reviews newsletter PRISMA statement Mastering Intensive Care podcast - Episode 32 with Kate Harding   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 50 with Andrew Davies Mastering Intensive Care podcast - Episode 51 - A Recap of 2019 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Anyone who has heard UK intensivist Prof Mervyn Singer speak at an Intensive Care conference will no doubt enjoy listening to him speak on this episode of Mastering Intensive Care. Mervyn Singer is Professor of Intensive Care Medicine at University College London in the UK. He was born, bred, trained, and now works in London as an intensivist and a researcher whose career spans from basic mechanistic work through to translational investigations and multi-centre trials. He co-chaired the ‘Sepsis-3’ international definitions task force, is Editor-in-Chief of Intensive Care Medicine Experimental and Treasurer of the International Sepsis Forum. Mervyn has published widely in a variety of journals and has authored or co-edited several textbooks including the Oxford Textbook of Critical Care. He was the first UK intensivist to be awarded Senior Investigator status by the UK National Institute for Health Research, and to be invited to give plenary lectures at the European and US Intensive Care Congresses. In this conversation Mervyn is full of his usual enthusiasm as we covered many important topics including: How he became an intensivist What he’s observed about the physiological basis of intensive care The clinical ward round process he follows The scheme in his ICU to allow patients to die at home How he leads an end of life conversation The benefits to having an ICU-based psychologist How institutions might better care for their junior staff How much he enjoys his career His "can do" attitude How his passion for sport has helped him His regular sleep pattern The value he receives from doing body stretching His use of email and social media Mentoring younger trainees Which of his research makes him most proud His tips for giving a good lecture Some excellent advice to conclude our conversation   I invite you to listen in to my conversation with Mervyn Singer.   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Mervyn Singer Prof Mervyn Singer Mervyn Singer brief CV   Links to other resources (in order of mentioning) David Bennett's Obituary (co-authored by Mervyn Singer) Edith Piaf The Cricket “Ashes” New Normal Project podcast   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 51 - A Recap of 2019 Mastering Intensive Care podcast - Episode 52 with Martin Bromiley Mastering Intensive Care podcast - Episode 53 with Paul Wischmeyer Mastering Intensive Care podcast - Episode 54 with Deborah Cook 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In this episode of the Mastering Intensive Care podcast we replay a previous episode which featured Deborah Cook (broadcast originally as episode 46). Deborah is an intensivist at St. Joseph’s Healthcare in Hamilton and Distinguished Professor of Medicine, Clinical Epidemiology & Biostatistics, and Academic Chair of Critical Care at McMaster University. Deborah has received numerous awards for her practice, teaching, mentoring and research, including an Officer of the Order of Canada. She is one of the evidence-based medicine pioneers, and has cultivated and led countless large international investigator-initiated intensive care research studies, mostly with the Canadian Critical Care Trials Group, which she was a Founder of, and which now awards the Deborah J. Cook Mentoring Award to recognise the huge number of people she has mentored around the planet. In this replayed interview from 2019, Deborah talks about the rekindling of her early career desire to study and practice better end of life care to improve the quality of the dying experience for patients and their families, with the Three Wishes project. She also gives her wise and experienced thoughts on the keys to success in research, ward rounds, family involvement in the ICU, her expectations as an ICU consultant, communication, note-writing, her own self-care and love for family, and some valuable closing career tips.   I invite you to listen to this replay episode with Deborah Cook.   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Deborah Cook Prof Deborah Cook Article about Deborah Cook Article 2 about Deborah Cook Video of Deborah Cook   Links to other resources (in order of mentioning) Canadian Critical Care Trials Group The 3 Wishes Project Publication from 3 Wishes Project Other publications from 3 Wishes Project David Sackett Book “Essentialism - The Disciplined Pursuit of Less” (by Greg McKeown) ANZICS Clinical Trials Group New Normal Project podcast   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 46 with Deborah Cook Mastering Intensive Care podcast - Episode 50 with Andrew Davies Mastering Intensive Care podcast - Episode 51 - A Recap of 2019 Mastering Intensive Care podcast - Episode 52 with Martin Bromiley Mastering Intensive Care podcast - Episode 53 with Paul Wischmeyer 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In this episode of the Mastering Intensive Care podcast we replay a previous episode which featured Paul Wischmeyer (broadcast originally as episode 35). Paul is a Professor of Anesthesiology and Surgery, the Director of Perioperative Research at the Duke Clinical Research Institute and the Co-Director of the Nutrition Support Service at Duke University Hospital in the United States. Paul works mainly as a perioperative, critical care, and nutrition physician focused on enhancing preparation and recovery from surgery and critical care. His academic career has led to large numbers of publications, grants and invited presentations. And what’s unique about Paul is that his passion for helping patients stems from his own personal experience as a patient. In this replayed interview from 2018, Paul describes how he ended up as a physician, after having disturbing and traumatic patient experiences (including procedures, medications and suboptimal communication) and how this has helped him to be a better doctor and an example and teacher to others. He also discusses topics including ward rounds, cooperating with a palliative care team, caring for ourselves, the importance of nutrition and exercise, good onstage presentation techniques, and some valuable closing tips for all of us.   I invite you to listen to this replay episode with Paul Wischmeyer.   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Paul Wischmeyer Paul Wischmeyer website Paul Wischmeyer at Duke University Paul Wischmeyer at Duke Health Paul Wischmeyer on Twitter: @Paul_Wischmeyer Paul Wischmeyer on LinkedIn   Links to other resources (in order of mentioning) 2019/2020 Australian Bush Fires American Delirium Society Prof Wes Ely SCCM ICU liberation initiative Book “Presentation Zen Design” (by Garr Reynolds) Prof Jean-Louis Vincent Prof Mervyn Singer   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 31 with Jean-Louis Vincent Mastering Intensive Care podcast - Episode 33 with Wes Ely Mastering Intensive Care podcast - Episode 35 with Paul Wischmeyer Mastering Intensive Care podcast - Episode 49 with Hugh Montgomery Mastering Intensive Care podcast - Episode 52 with Martin Bromiley 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In this episode of the Mastering Intensive Care podcast we replay a previous episode which featured Martin Bromiley (broadcast originally as episode 21). Martin is an airline captain, whose wife Elaine Bromiley sadly died in tragic circumstances, the story of which he describes here and is also documented in the video “Just a routine operation”. Martin used his experience in human factors to found and now lead the Clinical Human Factors Group, the charity working to make healthcare safer, by combining the efforts of academics, clinicians, leaders and policy makers. His work is widely recognised and his many awards include an Order of the British Empire (OBE), the Royal College of Anaesthetists Medal and Fellowship of the Royal College of Surgeons of Edinburgh. In this replayed interview from 2017, Martin tells Elaine’s sorry story, describes how he dealt with it, and the support he received, before going on describe his work and the founding of the Clinical Human Factors Group, what he thinks is required to improve safety in healthcare, what healthcare can and cannot learn from aviation, the importance of honesty about errors, the 3 key lessons in human factors for clinicians, how he uses mental rehearsal in his role as an airline pilot, and a final important tip about listening.   I invite you to listen to this replay episode with Martin Bromiley.   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Martin Bromiley Martin Bromiley Martin Bromiley on Twitter: @MartinBromiley Martin Bromiley on LinkedIn Clinical Human Factors Group Donations to Clinical Human Factors Group Video “Just a routine operation” Video “How to Fail…Part Two” (a talk by Martin Bromiley at DasSMACC conference) Video “Martin Bromiley, a Patient’s Perspective” (talk by Martin Bromiley at Patient Safety Movement) Anonymous version of an Independent Report on the death of Elaine Bromiley Article “The husbands story: from tragedy to learning and action” (authored by Martin Bromiley) Article "Clinical Human Factors" (co-authored by Martin Bromiley) Article 1 on Martin Bromiley Article 2 on Martin Bromiley Article 3 on Martin Bromiley Article “Lessons from the Bromiley Case” (by Mike Cadogan on Life In The Fast Lane)   Links to other resources (in order of mentioning) SMACC TED Book “Black Box Thinking” (by Matthew Syed) Paper on the Safety 1 and Safety 2 model Second paper on the Safety 1 and Safety 2 model Third article on the Safety 1 and Safety 2 model Jim Harlow on Twitter   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 21 with Martin Bromiley 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Happy New Year. Thanks for listening to Mastering Intensive Care in 2019. If you reflect on and put into action many of the perspectives shared on this podcast, and if your colleagues do too, I truly believe your ICUs should improve in the care you deliver. That’s not to say you don’t do well already. It’s rather to suggest that the topics we cover on this podcast are not covered well in textbooks and journals, and are often better relayed through the stories and experience of the real people I talk to with the “fly on the wall” intimacy that audio podcasts allow. In this 2019 recap episode you will either hear some of the interview guests you may have missed, or you will re-listen to some of the topics & people I selected, so as to showcase several of the themes this show focuses on. For the third year in a row I have simply been astounded by just how much I personally have valued and learned from the perspectives, stories and wisdom of the people I’ve interviews on the show in the last 12 months. This is my thank you to each of those guests (even if they haven’t been highlighted today). It’s also my thank you to you, whether you are a first-time or long-time listener, and a special thank you to all who have helped me by sharing the show with others. I couldn’t include all 2019 guests so I picked the excerpts I enjoyed rehearing. I am sorry if I left out someone you might have included. If you did miss some of the episodes, here is your chance to catch up. If you are a new listener, this series of audio snippets is what I feel best characterises the show. The 6 extracts are from interviews with Rana Awdish, Matt Morgan, Jo Stewart, Laura Rock, Paul Young & Ed Litton. I hope you do enjoy what I see to be as a virtual cramming of the 2019 Mastering Intensive Care curriculum, packaged up into just over an hour of listening, that should really help you to bring your best self to work in 2020.   Thanks for listening.   Andrew Davies   --------------------   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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links to the 6 interviews excerpted (in order of playing) Mastering Intensive Care podcast - Episode 41 with Rana Awdish Mastering Intensive Care podcast - Episode 47 with Matt Morgan Mastering Intensive Care podcast - Episode 43 with Jo Stewart Mastering Intensive Care podcast - Episode 48 with Laura Rock Mastering Intensive Care podcast - Episode 42 with Paul Young Mastering Intensive Care podcast - Episode 40 with Ed Litton   Links to resources (in order of mentioning) See above links for more information about individual guests and the resources discussed in each excerpt New Normal Project podcast Rich Roll Podcast Rich Roll Podcast - Episode 488 (Best of 2019 Part 1) Mastering Intensive Care podcast - Episode 15 with Peter Brindley New Normal Project podcast - New Normal in Action episode (October 2019) New Normal Project podcast - New Normal in Action episode (November 2019) New Normal Project podcast - New Normal in Action episode (December 2019) Mastering Intensive Care podcast - Episode 45 with Scott Weingart EMCrit podcast - Episode 252 Mastering Intensive Care podcast - Episode 49 with Hugh Montgomery Mastering Intensive Care podcast - Episode 50 with Andrew Davies   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

To celebrate the 50 episode milestone, podcast host and intensivist Andrew Davies (yes that’s me) is in the spotlight. Having started the show to learn perspectives that could help me, as well as you, to be better and more human healthcare professionals, I’ve published 49 episodes with some amazing guests. Based on many of you asking for this, I finally plucked up the courage and switched the microphones so I’m the one being interviewed. I also had the very difficult task of picking an interviewer and eventually chose my good friend, Neil Orford, who was one of the early, and very popular, guests on the show. He got the gig because he and I usually have outstanding conversations based mostly around Neil's curiosity and his interest in things that aren’t the “bread and butter” topics of Intensive Care. If you want to know more about Neil, listen to episode 4. If you want to know more about me, listen in here. Neil asks me about all sorts of topics including: What’s changed as I’ve done the previous 49 episodes The common themes I’ve identified on the show How I incorporate kindness, compassion and a team approach to my work Some reflections on ward rounds I lead Showing respect to the ICU team My thoughts on listening Transitioning from a tertiary ICU to a smaller ICU Why I pivoted from an academic career to a focus on podcasting and wellness My advice about wellness for Intensive Care practitioners What I think are the key planks for my health and wellbeing Some thoughts on moderation and tolerance Whether I still enjoy being an intensivist What my life might look like in 5 years And my thoughts on the future of Intensive Care I hope you enjoy our conversation. Andrew Davies -------------------- 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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Andrew Davies Andrew Davies at Peninsula Health Andrew Davies profile at World Congress of Intensive Care Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn   Links related to Neil Orford Neil Orford at Barwon Health Neil Orford profile at World Congress of Intensive Care Neil Orford at Deakin University Neil Orford on Twitter Neil Orford on LinkedIn   Links to resources (in order of mentioning) Mastering Intensive Care podcast - Episode 4 with Neil Orford Mastering Intensive Care podcast - Episode 29 with Claire Davies Mastering Intensive Care podcast - Episode 2 with John Botha Mastering Intensive Care podcast - Episode 49 with Hugh Montgomery Prof Hugh Montgomery Mastering Intensive Care podcast - Episode 9 with John Myburgh Prof John Myburgh Mastering Intensive Care podcast - Episode 3 with Rinaldo Bellomo Prof Rinaldo Bellomo ANZICS Clinical Trials Group New Normal Project podcast Book “Thrive” (by Ariana Huffington) Ariana Huffington   Other interviews of and presentations by Andrew Davies Interview 1 Interview 2 Interview 3 Presentation 1 Presentation 2   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

Climate change is a conversation we need to be having in Intensive Care circles. Right now. If the environmental catastrophe that is unfolding around us continues unabated there may no longer even be Intensive Care Units. The rising global temperatures, the melting ice, the extreme weather events, and their impact on agricultural crops and human habitation may well lead to such a fall in the economy that our healthcare system may not have the financial resources it does now. And given ICUs are the most expensive part of our hospitals, have a guess what might disappear first. So who is there better to listen to about the climate crisis than British intensivist, Professor Hugh Montgomery, a deeply passionate and highly intelligent man, who was a founding member of the UK Climate and Health Council, and who has helped raise awareness about climate change for over 2 decades. In this episode Hugh outlines some simple things you can do today to help fight climate change. Hugh is a Professor and the Director of the Institute for Human Health and Performance at University College London. He obtained a 1st class degree in cardiorespiratory physiology and neuropharmacology before graduating from the Middlesex Hospital Medical School in 1987. He has since obtained specialist accreditation in Cardiology, General Internal Medicine and Intensive Care medicine, and practices as a Consultant Intensivist in North London in the UK. Hugh obtained his MD(Res) in 1997, is known for his pioneering genetic research, and has published over 450 peer reviewed papers, three in Nature. Hugh is also an author of children's books, and most recently of the medical thriller ‘Control’. Hugh has a such diverse array of interests and expertise that it’s hard to understand how he fits it all in. He has presented on television shows, climbed tall Himalayan mountains, run ultra-marathons, jumped naked from a plane at 14,000 feet, holds the world record for underwater piano playing, and also consults as a medical expert on Artificial Intelligence. Despite all of this, he continues to work as a clinical intensivist, publishes in the medical literature about important critical care topics, and is working to raise patient awareness about their end of life wishes. To me this is one of the most important Mastering Intensive Care episodes so far, as in a wide-ranging conversation Hugh talks about: How he became interested in physiology and then intensive care The intensivists that shaped his career Climate change and why we all need to care What actions we can take today as Intensive Care professionals to help the environment His own views on diet, renewable energy and international flights Some perspectives on the ICU ward round The importance of relationships and building connection with patients in clinical medicine How his father’s experience in hospital informed Hugh How “wisdom of the crowd” assists in making diagnoses Dealing with uncertainty at the bedside The importance of speaking to patients about end of life before they are admitted to the ICU How he speaks to families of the dying An end of life project he and his colleagues are working on Why he researches what he does Some tips for public speaking How the emergence of artificial intelligence might play out in healthcare Why we need to be engaged with Big Tech His own attitudes and practice of self-care and self development His non-medical writing, including his new medical thriller book “Control” I can not recommend more highly that you settle in and listen to this amazing man, Professor Hugh Montgomery. Andrew Davies   -------------------- 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. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   -------------------- Links related to Hugh Montgomery Hugh Montgomery at UCL Hugh Montgomery at Whittington Hospital Hugh Montgomery at ISEH Hugh Montgomery profile Hugh Montgomery on Twitter PubMed search for Hugh Montgomery Book “Control” (by Hugh Montgomery) Book “Control” (by Hugh Montgomery) Book “Control” (by Hugh Montgomery) Book “Cloudsailors” (by Hugh Montgomery) Book “Voyage of The Arctic Tern” (by Hugh Montgomery) Review of “Control” (by Hugh Montgomery) Article 1 about “Control” (by Hugh Montgomery) Article 2 about “Control” (by Hugh Montgomery) Interview of Hugh Montgomery on Desert Island Discs Interview of Hugh Montgomery on BBC Press article 1 featuring Hugh Montgomery Press article 2 featuring Hugh Montgomery Press article 3 featuring Hugh Montgomery Press article 4 featuring Hugh Montgomery   Links to people, organisations and other resources as mentioned in order throughout podcast Physiologist Eric Neil 
Samson Wright’s Applied Physiology 13th edition Hammersmith Hospital Article discussing Ron Bradley Gillian Hanson Information about Hugh Montgomery’s 2019 talk at SMACC (video not released) Lancet Commissions 2009: “Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission” Lancet Commissions 2015: “Health and climate change: policy responses to protect public health” Lancet Countdown 2017: "The Lancet Countdown: tracking progress on health and climate change" Lancet Countdown 2018: "The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health" Lancet Countdown 2018: "The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come" Lancet Countdown: Tracking Progress on Health and Climate Change Lancet on “Health and Climate Change” Lancet Infographic on “Climate Change and Health” Philosophical Transactions of The Royal Society Book “Eat & Run” (by Scott Jurek) Nature paper on microbiome and elite athletes Carbon Footprint Calculator SMACC Oli Flower Roger Harris CODA change Trillion Trees Trillion Trees Australia Whittington Hospital ITU/Critical Care University College Hospital London Andy Webb 
Reading Hospital YouTube search for Hugh Montgomery Moore’s law Deep Neural Networks Nature Medicine paper co-authored by Hugh Montgomery “Clinically applicable deep learning for diagnosis and referral in retinal disease.” Nature paper co-authored by Hugh Montgomery “A clinically applicable approach to continuous prediction of future acute kidney injury.” Google Health Particle physics New Normal Project podcast New Normal Project podcast - Episode 45 with Neal Barnard New Normal Project podcast - Episode 48 with Caldwell Esselstyn New Normal Project podcast - Episode 38 with Michael Klaper New Normal Project podcast - Episode 43 with Kim Williams New Normal Project podcast - Episode 49 with Scott Stoll New Normal Project podcast - Episode 51 with Alan Desmond “2040” Movie CODA 2020 Mastering Intensive Care podcast - Episode 48 with Laura Rock   Links related to Mastering Intensive Care 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 Audio Producer Chris Burke

Are you a good communicator? Can you identify the skills of optimal communication? Might you sometimes respond to emotion with facts? Communication is perhaps the most important thing we do in healthcare, let alone in life. And to support our patients in understanding their ill health and their healthcare needs requires a high level of human connection for communication to be optimal. So let me introduce you to Dr Laura Rock, an American intensivist, who reminds us on this podcast that (1) communication skills are learnable, (2) there are benefits in understanding our patients emotionally, (3) we can help patients greatly if we don’t try to reassure with facts when we hear emotions in the words they use, and (4) a focus on transparency, respect and curiosity can help us all to understand each other better; all of which seem likely to help us in our roles in the Intensive Care Unit. Laura is a Pulmonologist, Intensivist and Director of Communication and Teamwork for Critical Care at Beth Israel Deaconess Medical Center in Boston, Massachusetts, an Assistant Professor at Harvard Medical School, Faculty for the Center for Medical Simulation and a VitalTalk instructor. Laura studies and teaches the role of emotion in critical conversations, debriefing, feedback, and interprofessional conflict negotiation. She thinks we can change the world one conversation at a time, when we truly listen, and when we allow for creative and collaborative possibilities. When not teaching or seeing patients in the ICU, Laura loves to spend time with her family and to hike, ski, mountain bike, surf and sing. In this episode you will hear Laura speaking about many aspects of communication, also including: How she got into critical care and then became focused on communication What good communicators do to make human connection How micro-encounters and casual interactions are all part of building trust The GIVE acronym she suggests for responding to people’s emotions (Get there is emotion, Identify the emotion, Validate the feelings, Explore to understand) Some examples of how to respond to what sound like comments with emotions Some thoughts on what to do when the person is angry How we should guess at people’s emotions, not tell them what they are feeling Her thoughts on touch including hugs How the universality of communication skills can help us with friends and family too Being specific when helping debrief a team The teaching she does on ward rounds How most poor communication interactions can be helped by saying sorry Her self care including her approach to exercise, nature, guitar-playing, sleep and balance The gratitude she feels for having recently spent a lot of time with her dying mother. Laura is kind, caring, astute, thoughtful and the sort of listener and communicator I would have liked to have been involved in the care of my father when he was dying, something we talk about towards the end of the episode. This one is really worth listening to, no matter how good you think your communication skills are. Please listen to and learn from Dr Laura Rock. Andrew Davies -------------------- 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 glean insights to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient’s lives. -------------------- Links to people, organisations and other resources mentioned: Laura Rock on Twitter Laura Rock at Beth Israel Deaconess Medical Center Laura Rock at Harvard Catalyst Laura Rock on LinkedIn Center For Medical Simulation VitalTalk Published papers by Tony Back and Bob Arnold 2019 World Congress of Intensive Care Medicine SMACC Melbourne marathon  Melbourne Cricket Ground Mastering Intensive Care podcast - Episode 47 with Matt Morgan 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

Have you visited any of your past patients or their families in their homes? Would this be difficult? What might you learn? Medicine is mostly a series of stories of people’s lives. This is a privilege we often overlook. In Intensive Care we usually only have a glimpse into each life, an almost unrecognisable flash of physical suffering, medical procedure, bedside vigil and hopefully recovery, but sadly we often miss the end of the story. What happened to that person? Did they recover? Did they regain their previous life? What do they remember? Dr Matt Morgan, a Welsh Intensivist, didn’t enjoy missing the end of these stories, and he wasn’t sure that laypeople really understood what we do in the ICU. So he took it upon himself to visit some of the patients or their families who he had helped care for in the Intensive Care Unit. And what he learned helped him write his recently published book “Critical - science and stories from the brink of life”. Matt is a Consultant in Intensive Care Medicine at the University Hospital of Wales, and an Honorary Senior Research Fellow at Cardiff University in the UK. After completing medical school in Cardiff, where he still lives and works, Matt studied ethics at Bristol University, served as a junior doctor in the RAF, and subsequently chose the path of intensive care medicine, training in the UK and Australia, and completing a PhD. Matt is passionate about public engagement and has contributed to multiple scientific articles. The book “Critical” takes readers on a tour around the intensive care unit, meeting some of his most interesting and memorable cases. These stories include a pregnant woman who survived for weeks without a heart beat, the son of a police officer who was critically injured in a drug lab explosion, a judge who returns to the court room where he needed CPR, and an 18-year-old student who sadly died from sepsis after a trip to Africa. Throughout the book, Matt also highlights public health messages like the importance of bystander CPR, the harms of alcohol, the benefits of organ donation and how medicine is currently battling what should be done with what can be done. In this podcast conversation you’ll hear Matt speak about his new book, and also about: How he has tried to mix science, history, emotions and humans together in his writing How hard it was to visit some of the patients and their families he wrote about in his book The value of doing this “deep follow up” The story of Vivi, who is understood to be the world’s first ever Intensive Care patient How we can increase our use of narrative medicine including in medical note writing The changes he’s made to the process of his ward round Some of his thoughts on burnout and how he deals with the demands of work The importance he places on sleep His views on mindfulness What he says and does in a family meeting The question he thinks is crucial in a family meeting How he involves trainees in these meetings Some advice for difficult conversations The value of reading outside of intensive care and outside of medicine His obsession with animal physiology His thoughts on changes we need to make in intensive care Matt is an excellent writer with a gift for describing disease and concepts very simply. He speaks articulately too. Please enjoy listening to Matt Morgan. Andrew Davies -------------------- 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 glean insights to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient’s lives.   -------------------- Links to people, organisations and other resources mentioned: Dr Matt Morgan website Matt Morgan on twitter Book “Critical” (by Matt Morgan) Blog piece “The ward round is broken” (by Matt Morgan) Blog piece “Burnout in healthcare workers - are we surprised” (by Peter Brindley and Matt Morgan) Other BMJ blog pieces by Matt Morgan Other blogs by Matt Morgan If this then that (IFTTT) Book “Why we Sleep” (by Matt Walker) Mastering Intensive Care podcast - Episode 40 with Ed Litton Mastering Intensive Care podcast - Episode 41 with Rana Awdish Mastering Intensive Care podcast - Episode 46 with Deborah Cook 2019 World Congress of Intensive Care Medicine New Normal Project podcast New Normal Project podcast - Episode 56 with Brad Dalrymple 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

What do you do for your patients around their dying experience? Do you celebrate their lives and support those left behind in grief? Could you bring more humanity to your ICU?   Whilst you and your ICU colleagues likely act with kindness much of the time, I suspect listening to this podcast will have you wondering whether you could do better, especially when your patients are receiving end of life care. This episode’s guest, Professor Deborah Cook, from Hamilton in Canada, is striving to do this through the 3 Wishes Project she and her colleagues initiated several years ago. They encourage specific wishes unique to their dying patients, thereby dignifying the person, giving greater voice to the family and evoking clinician compassion. In this podcast you will hear all about this profound and important work, the sort of acts of kindness that have occurred in her ICU, the way you could approach this in your ICU, the benefits to clinical staff and institutional leaders, some of the logistical challenges they’ve faced, and some thoughts on spiritual care in the ICU. Deborah Cook is a Distinguished Professor at McMaster University in the Departments of Medicine, Clinical Epidemiology and Biostatistics. As a life long clinician-scientist, she holds the first Canada Research Chair in Intensive Care Medicine and is the Academic Chair in Critical Care Medicine at McMaster. She is a founding member and 2-term Chair of the Canadian Critical Care Trials Group. Deborah is an active practitioner in critical care medicine at St. Joseph’s Hospital where she supervises junior and senior clinical trainees. She is devoted to mentoring Masters and PhD graduate students in McMaster's Health Research Methodology Program, and junior faculty around the world, resulting in the creation of the Deborah J Cook Mentorship Award by the Canadian Critical Care Trials Group. Deborah has published over 700 peer-review articles with an associated H index of 168. Her multi-method multi-disciplinary research interests include life support technology, prevention of ICU-acquired complications, end-of-life care, and research ethics. She has received numerous national and international awards for her practice, teaching, mentoring and research. She is a pre-eminent critical care scholar. Dr. Cook was inducted as a Fellow of the Royal Society of Canada (2009), a Fellow of the Canadian Academy of Health Sciences (2010), and received the inaugural Distinguished Lecturer Award in Critical Care Sciences from CIHR's Institute of Circulatory and Respiratory Health (2017). Her work on microbiome modification in critical illness using probiotics resulted in a prestigious Killam Fellowship in Health Sciences from the Canadian Council of the Arts (2017). Deborah received the Gold Leaf Award from CIHR for her enduring contributions to health care (2019). For life long scientific contributions to the improvement of global intensive care and her foundational leadership in the first national ICU research network in the world, Dr. Cook was appointed an Officer of the Order of Canada (2016). In this conversation Deborah also talks about: How she was drawn to intensive care from internal medicine How she discovered several gold mines to conduct research on Her belief that following your passion is the key to research success How humanity has fallen by the wayside as intensive care has developed How she was dissuaded from doing end of life research early in her career The growing interest in ethics and end of life care How she approaches ward rounds Dealing with our fixation on computer screens Being present and avoiding note-writing on ward rounds Her high expectations as a clinical mentor (including of herself) The importance of presence and engagement as the attending consultant The irrelevance of many of the words spoken on ward rounds The importance of keeping things fresh by releasing dying passions Her thoughts about how she cares for herself Which exercise and which books she prefers Her mindfulness practice Her love for family Some invaluable career tips Deborah is passionate about patients receiving the very best care, about clinicians delivering this in an organised and cohesive fashion, and about researchers providing the highest quality evidence to guide this. She has been a kind friend and advisor to me over many years and I can’t think of anyone with a better mix of acumen, experience and personality as the ideal Mastering Intensive Care podcast guest. She is a personal favourite so please enjoy listening to the wonderful Deborah Cook.   Andrew Davies   -------------------- 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 glean insights to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient’s lives.   -------------------- Links to people, organisations and other resources mentioned: Deborah Cook (McMaster University) Article about Deborah Cook Article 2 about Deborah Cook Video of Deborah Cook Canadian Critical Care Trials Group PROTECT study comparing dalteparin and heparin The 3 Wishes Project Publication from 3 Wishes Project Other publications from 3 Wishes Project ANZICS Clinical Trials Group David Sackett Book "Essentialism – The Disciplined Pursuit of Less" (by Greg McKeown) Mastering Intensive Care podcast - Episode 45 with Scott Weingart EMCrit podcast 2019 World Congress of Intensive Care Medicine New Normal Project podcast Plantfit Summit 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

Today’s guest is Scott Weingart, the pioneer podcaster in the intensive care field through his EMCrit podcast. Scott is an ED Intensivist from New York, where he is Chief of the Division of Emergency Critical Care at Stony Brook Hospital and a Professor of Emergency Medicine at Stony Brook Medicine. Scott has devoted his career to bringing "Upstairs Care, Downstairs" (ie. bringing ICU care down to the ED - where it needs to be). He loves his job taking care of the sickest patients, innovating new ways to do it better, and then teaching these concepts to his residents. Of course, none of that is nearly as much fun as playing with his son, Mace. Scott is best known for talking to himself about Resuscitation and Critical Care on the EMCrit podcast, which has been downloaded over 20 million times. EMCrit is also a hugely valuable blog and educational resource. In this conversation Scott talks about: How he trained to be where he is now as an ED intensivist What inspired his mission to improve critical care prior to ICU admission How he got into podcasting The benefit of putting his views out into the online community How podcasting and new media can allow the “small to be seen” The automatic peer review built in to his podcasting The value he’s had from SMACC conferences and the FOAM movement His obsession to improve What a day in his life is like How his martial arts experience spurned his meditation practice What his minimal effective dose of meditation is His thoughts and use of negative visualisation and mental rehearsal The value of errors in improving ourselves The need to be care- rather than people-orientated in resuscitation How his communication is changing over time The use of dramatic pauses to spur knowledge translation and learning His advice on reading And some of his favourite books and podcasts Scott is a deep-thinking man, very focused on understanding and practicing well considered and patient-oriented care particularly at the resuscitation end of intensive or critical care medicine, and is very good with spoken language. Please enjoy listening to Scott Weingart. Andrew Davies   -------------------- 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 glean insights to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient’s lives.   -------------------- Links to people, organisations and other resources mentioned: Scott Weingart Scott Weingart on Twitter: @emcrit EMCrit podcast & website Liz Crowe Essay: The Thousand True Fans (by Kevin Kelly) Seth Godin SMACC Talk by Scott Weingart “The Path to Insanity” Talk by Scott Weingart “Kettlebells for the Brain” Mastering Intensive Care podcast - Episode 21 with Martin Bromiley Book “House of God” (by Samuel Shem) Cliff Reid Chris Hicks Sara Gray Mastering Intensive Care podcast – Episode 13 with Sara Gray Book “A Confederacy of Dunces” (by John Kennedy Toole) Book “Catch 22” (by Joseph Heller) 99% Invisible podcast Radiolab podcast The Flop House podcast Mastering Intensive Care podcast – episode 44 with Geoff Toogood Crazy Socks 4 Docs 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

To help raise awareness about #CrazySocks4Docs this episode’s guest is Dr Geoff Toogood. Geoff is a Cardiologist at Peninsula Health and in Private Practice in Melbourne, Australia. He is also a Board Member of South West Health Care, Ambassador for Beyond Blue and Ambassador for Masters Swimming Victoria. He is both a pool and open water swimmer, having competed at National and International level, using swimming for his mental wellbeing. Geoff has completed a relay across the English Channel, swum solo in the Rottnest Island swim and many other open water and pool swims. Despite having a cardiologist on the show, this is mostly a talk about mental health, rather than cardiology. Geoff has had his share of mental health struggles, having had a period of anxiety early in his career and then more recently severe depression leading to suicidal ideation. But most importantly, Geoff has used his story, told humbly and vulnerably, to create awareness about Doctors mental health and to break the stigma, through the CrazySocks4Docs movement, which you’ll hear about today. All healthcare workers are at risk of mental health issues. They are more common than we realise. Mental health disorders can lead to burnout, divorce and suicide. We must talk more about this issue; so we can understand this, do things to help reduce the risk, and to help each other when we identify mental ill health in our colleagues. If we talk about this as an industry, we will hopefully all be better off. We, ourselves. Our colleagues. And more importantly, our patients. The conversation on this podcast covers: Why Geoff got into medicine and then into cardiology How cardiology has changed over his career His mental health journey starting with anxiety as a younger doctor How this progressed to depression and then suicidal ideation Some of the symptoms he felt, and the ways he supported himself His need to take leave from work and what that meant The problems of needing to see mental health professionals Dealing with telling his colleagues at work The contribution of a medical work schedule and other life stressors His current wellbeing strategies including sleep and swimming His impressive swimming career and how this acts as mindfulness How helpful it’s been to him to tell his story Thoughts on resilience and the stigma of mental ill health How the Crazy Socks For Docs movement began About the 2019 #CrazySocks4Docs day on June 7th The #CrazySocks4Docs Panel Discussion being held on May 31st 2019 How his mental health is now The value of mindfulness and yoga as wellbeing tools Hearing about Geoff’s struggles, how he has dealt with them, and his ongoing advocacy, is more than helpful. It’s powerful. Please enjoy listening to Geoff Toogood.   Andrew Davies   -------------------- 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 glean insights to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient’s lives.   -------------------- Links to people, organisations and other resources mentioned: Geoff Toogood on Twitter: @gdtoogood Crazy Socks For Docs website Crazy Socks For Docs on Twitter: @crazysocks4docs Crazy Socks For Docs on Instagram: @crazysocks4docs Crazy Socks For Docs on Facebook Geoff Toogood on LinkedIn Peninsula Health South West Health Care Masters Swimming Victoria Beyond Blue Lifeline English Channel Swim Pier to Pub Swim  Portsea Swim Classic Rottnest Island Swim Dr Sally Cockburn Prof Michael Myers on Twitter: @downstatedoctor Dr Kate Harding on Twitter: @katejh1970 Dr Yumiko (Miko) Kadota on Twitter: @mindbodymiko  Article 1 written by Geoff Toogood Article 2 written by Geoff Toogood Articles 3 & 4 written by Geoff Toogood Article 1 written about Geoff Toogood Article 2 written about Geoff Toogood Article 3 written about Geoff Toogood Article 4 written about Geoff Toogood Article 5 written about Geoff Toogood Article 6 written about Geoff Toogood Article 7 written about Geoff Toogood Article 8 written about Geoff Toogood Video of talk by Geoff Toogood Video of TV show featuring Geoff Toogood New Normal Project podcast New Normal Project podcast - Episode 53 with John Orchard Mastering Intensive Care podcast - Episode 32 with Kate Harding Mastering Intensive Care podcast - Episode 43 with Jo Stewart 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

On International Nurses Day, please listen to Jo Stewart, the Clinical Nurse Unit Manager at the ICU in which I work - Frankston Hospital. On May 12th, the date that commemorates the birthdate of Florence Nightingale, we celebrate every single one of the many nurses who support and care for us when we are sick. Pretty much everyone on earth comes in contact with a nurse and, for us in intensive care, nurses are so important to all that we do. Let me simply say thank you to the nurses of the world. You are the lifeblood of healthcare, and especially in hospitals. I have learnt from watching hundreds of you; about how to better care for a patient, about how to better communicate, and how to better support a critically unwell person and their loved ones. If you read the cards that are sent to the ICUs when the patients and their families want to say thank you, you’ll see who they value the most. Our nurses are simply amazing. On this episode I speak with Jo Stewart. Her role as Clinical Nurse Unit Manager allows her to offer training and support to the nurses of Frankston ICU as well as to work on quality and operational requirements of the unit. Jo is passionate about education and supporting novice nurses and brings experience from a variety of specialty ICU nursing areas such as Cardiothoracics (including ECMO), Neurosurgery, and Critical Care Liaison Nursing. Jo completed her Masters in Intensive Care Nursing at The Alfred Hospital in 2007, worked in Vancouver, and then commenced working at Frankston Hospital as a Clinical Support and Development Nurse in ICU in 2011 whilst concurrently lecturing at Monash University for both Undergraduate and Post Graduate Nursing courses. In the episode Jo speaks about: How she got into ICU nursing and what she enjoys about it Attracting and retaining ICU nurses The various roles she has worked in throughout her career Educating nurses How Jo educates herself Leading as a nurse unit manager Creating the right culture as a leader How she allocates her own time to different tasks Interactions between doctors and nurses in the ICU Principles of good communication Her self-care practices Encouraging wellness for the nursing workforce Working better as a team Some tips for the ICU doctors Jo is extraordinarily passionate and enthusiastic about her role. She is very welcoming, always happy for a chat, and I thought she would make an excellent guest for the show. Please enjoy listening to Jo Stewart.   Andrew Davies   -------------------- 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 glean insights to help you improve as a healthcare professional and as a human being so you can make the most valuable contribution to your patient’s lives.   -------------------- Links to people, organisations and other resources mentioned: Jo Stewart on Twitter: @JoStu82  Frankston Hospital ICU website BASIC for nurses FOAM (free open-access medical education) Insight Timer Smiling Mind 1 Giant Mind Mastering Intensive Care podcast: Episode 42 with Paul Young 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

What it is like when a much loved and respected leader in your Intensive Care suddenly dies? And do you view the people you work with in your ICU as an extended family?   Paul Young, an Intensivist from New Zealand, discusses his perspectives on these questions, amongst many other valuable insights, in this important and moving interview. Paul Young is an intensive care specialist at Wellington Hospital in New Zealand where he is the co-clinical leader at Wellington ICU. He is also medical director of Wakefield Hospital ICU, Deputy Director at the Medical Research Institute of New Zealand, and holds a Clinical Practitioner Research Fellowship from the Health Research Council of New Zealand. Paul's predominant non-clinical interest is in ICU research. Since starting work as an intensive care specialist in 2010 he has published more than 120 papers in peer-reviewed journals including five papers in the New England Journal of Medicine, two in JAMA, and one in the Lancet. His involvement in clinical research has been instrumental in the development of his belief that intensive care is fundamentally about keeping people alive for long enough for them to recover whilst meddling as little as possible. In his leadership roles he encourages people to find joy in their work and to be nice to each other yet he constantly battles with his own tendency towards sarcasm. In late 2018, Dr Peter Hicks, the Clinical Lead at Wellington Hospital died suddenly. Peter was an excellent intensivist, a wonderful leader, and a friend to many in the Australian and New Zealand ICU community. His death is sad for all who knew him and most notably his family and colleagues. Paul speaks in this interview about the legacy Peter left behind, how Peter particularly guided Paul in his career and how the Wellington ICU is moving on after Peter’s untimely death. In this conversation, Paul also discusses: Why he became an intensivist The cultural differences between Australia and New Zealand Telling the truth about his thoughts on the patient’s likely outcome Worrying - and when it's useful and not useful The specifics of his ward round What it’s like to have consultants changing daily in his ICU The start to his research career Some insights on designing clinical trials to answer important questions Why “negative studies” are so important to advance clinical practice (using the TARGET study as an example) How he keeps up with the literature including with Twitter His efforts to be more kind and to get on with people The effects of running on his general wellbeing A challenge for other units to try a “day about” clinical roster Paul is clever, incisive, and is delightfully able to simplify many concepts about intensive care practice and research. Please enjoy listening to Dr Paul Young.   Andrew Davies   --------------------   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 glean insights to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient’s lives.   --------------------   Links to people, organisations and other resources mentioned: Paul Young on Twitter: @dogICUma Wellington ICU website Tribute to Peter Hicks written by David Pilcher ANZICS CTG (Australian and New Zealand Intensive Care Society Clinical Trials Group) Rinaldo Bellomo Critical Care Reviews Rob MacSweeney Wellington ICU Journal Club on Twitter: @WellingtonICU TARGET study Tweetorial on the TARGET study by Paul Young Rana Awdish on Twitter: @RanaAwdish Book "In Shock" (by Rana Awdish) Mastering Intensive Care podcast: Episode 3 with Rinaldo Bellomo Mastering Intensive Care podcast: Episode 19 with Alex Psirides Mastering Intensive Care podcast: Episode 20 with Jack Iwashyna Mastering Intensive Care podcast: Episode 23 - The Best of 2017 (Part 1) Mastering Intensive Care podcast: Episode 24 - The Best of 2017 (Part 2) Mastering Intensive Care podcast: Episode 39 - The Best of 2018 Mastering Intensive Care podcast – episode 41 with 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: [email protected]  

If you work in healthcare and haven’t read the book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope” I really hope you will. In the meantime listen to intensivist and best-selling author Dr Rana Awdish on this week’s episode of Mastering Intensive Care and you’ll understand why. In her book, Rana brilliantly tells the real-life story of her near-death experience and subsequent recovery into which she weaves insightful observations and reflections on both the good and the bad of the healthcare she witnessed. Whilst Rana would have died without the excellence of the team who managed her sudden medical crisis the seeming lack of humanity was stark and frequently counterproductive. At the time Rana was in the final days of her Critical Care Fellowship in Detroit. Now an intensivist and frequent public speaker she has ample experience and expertise to assist intensive care clinicians to improve, the aim of this show. Rana graduated from Wayne State University School of Medicine in Detroit, completed Internal Medicine residency in New York, and then Pulmonary and Critical Care Medicine Fellowships at Henry Ford Health System in Detroit where she now works. She is Assistant Professor at the Department of Internal Medicine, Director of the Pulmonary Hypertension program, Senior Staff Physician in the Department of Pulmonary and Critical Care Medicine and Medical Director, Care Experience. Amongst many accomplishments she is the Physician Facilitator for the CLEAR Conversations program, teaches on communication, bioethics and physician wellness, and has won the National Compassionate Caregiver of the Year Award at the Schwartz Center for Compassionate Healthcare. Apart from beautifully describing how it really felt to be a patient, Rana also talks about: The suboptimal communication encounters she remembers Her gratitude for the skill and grace she received The benefits of being more engaged and connected with our patients Why first impressions matter The value of curiosity Using mindfulness to enhance presence What being cut off from knowledge as a patient felt like Her experience of asking for working suction in her own operation The value of community in unburdening ourselves as health practitioners How Schwartz rounds can be helpful The very first patient she met after recovering from her illness Her belief that showing compassion will make you more efficient The healing effect of family member presence The benefits of self-care (and what Rana does herself) The part spirituality might play in healthcare Better understanding the use of opiates and pain management Going home after a chronic critical illness How the whole experience has affected how she acts on ward rounds Our own healthcare experiences should not be the main driver towards the compassionate and caring practitioners our patients need. But as you’ll hear in this episode, they can deliver the sort of truth and learning we may not otherwise find. Please enjoy listening to Dr Rana Awdish.   Andrew Davies   --------------------   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 glean things to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient’s lives.   --------------------   Links to people, organisations and other resources mentioned: Rana Awdish on Twitter @RanaAwdish Rana Awdish website Book "In Shock" (by Rana Awdish) Mastering Intensive Care podcast – episode 35 with Paul Wischmeyer CLEAR conversations Schwartz Center for Compassionate Healthcare Kenneth Schwartz Schwartz rounds Mindful Practice with Ronald Epstein and Mick Krasner New York Times article “After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea” (by Firoozeh Dumas) Mastering Intensive Care podcast – episode 40 with Ed Litton SMACC 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

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   -------------------- 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.   -------------------- 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   -------------------- 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   -------------------- 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    -------------------- 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   -------------------- 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   -------------------- 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   -------------------- 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. --------------------  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   -------------------- 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]

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 [email protected]. 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: [email protected]

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 [email protected]. 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: [email protected] 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 [email protected]. 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: [email protected] Twitter handle for Andrew Davies: @andrewdavies66

How well do you understand what happens to your patients after they leave the ICU? Do you find out how they go and feed this back to your ICU team?   Most of you give excellent care to your patients whilst they are in the intensive care unit. No doubt this will be compassionate, appropriate, diligent, information-driven, holistic, team-based and communicative care. But when they leave the ICU, do you know what happens to them? Do you know if they actually leave the hospital? Do you know how they sleep, how long they remain confused for? What their final diagnosis on hospital discharge was? This is what A/Prof John Santamaria genuinely cares about. This is what he endeavours to find out. He is curious. John wants to know these things so he can better inform his patients before they leave the ICU and so he can keep his team up to date with what happened. Of course much of it is straightforward. The lady with pneumonia gradually got better and went home. The old man who had the laparotomy remained confused for 10 days, and then gradually became well enough to go off to rehabilitation. But sometimes there are surprises. The woman you thought had a simple urinary tract infection actually developed a secondary pneumonia in the ward and died after the treating team deemed another round of ICU to be inappropriate. The man with the acute pulmonary oedema who rapidly responded to CPAP but then developed a pulmonary embolism out on the ward. I know I could do better at understanding these things. It’s not that I’m not curious, it’s more that I get busy with the new patients, or the other jobs I have. Or recording the next podcast! I think after listening to this episode of Mastering Intensive Care with John Santamaria, you might think a bit about following up your ex-ICU patients more carefully. John is Director of Intensive Care at St Vincent’s Hospital in Melbourne, Australia. He trained both at St Vincent’s and Royal Melbourne Hospitals, in respiratory and intensive care medicine. After completing a doctorate of medicine on the control of breathing and postdoctoral studies in Vancouver, Canada, he returned to St Vincent’s in 1985. John has been a past chair of the Victorian branch of ANZICS and President of ANZICS. He currently chairs the Victorian Intensive Care Data Review Committee. His interests include mechanical ventilation, performance monitoring, clinical outcomes and clinical informatics. John is the current longest-serving Director of Intensive Care in Melbourne and anyone who works at St Vincent’s speaks so highly of his clinical care and his departmental leadership. He willingly let me interview him and we talked about a range of topics including: How he came to intensive care from respiratory medicine His appointment as ICU director at age 28 How some of his early career mentors influenced him The importance of close examination of patients How he balances teaching and clinical work on a ward round His perspectives on an electronic medical record and how the data from it can improve the quality of practice The need for intensivists to be open to suggestions from other team members The regular offer he makes to his nurses to call him when he is on call His take on end of life care and the family conversations involved How he collects data on his ICU’s patients on a daily basis (now over 30,000 patients) The use of technology like list managers, automatic reminders and SMS notifications of abnormal results His love of exercise, particularly early in the morning John’s advice on how to have a medical literature reading program Some thoughts about sleep, sleep deprivation and alerting medications And a few regrets he has... 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 [email protected]. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   -------------------- Show notes (people, organisations, resources or links mentioned in the episode) MANIC Course: https://www.baxterprofessional.com.au/manic/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

How do you balance the use of your clinical experience with the literature-based evidence? Are you a good enough listener? Is the clinical handover in your ICU the best it could be?   I’ve been reflecting on these questions since I talked to A/Prof Peter Kruger for this week’s Mastering Intensive Care podcast. Peter is Deputy Director of Intensive Care at the Princess Alexandra Hospital in Brisbane, Australia and an Associate Professor at both the University of Queensland and Monash University in Melbourne. He holds specialist qualifications in both Anaesthesia and Intensive Care and has experience in both laboratory and clinical research. He is the immediate past chair and a senior examiner for the first part examination of the College of Intensive Care Medicine of Australia and New Zealand and a primary examiner for the Australian and New Zealand College of Anaesthetists. He is a board member of the College of Intensive Care Medicine and of The Intensive Care Foundation. In addition to his clinical and teaching roles his active research interests include clinical trial design, utilising clinical information systems to facilitate research, weaning patients from mechanical ventilation and the management of severe sepsis. Peter is one of those doctors who mixes research, teaching and clinical care really well. So he is perfectly placed to speak on a bunch of topics in this episode, like: How the people and the variety keeps him coming back to work in the ICU Why he enjoys working in a “strong” ICU and what that means Some of the habits he noticed in his mentors The importance of not being in a rush when on clinical duties The varying style of his clinical ward rounds The value of making brief contact with families during bedside handovers What he talked about when he recently gave a presentation entitled “Does what I think I know matter anymore?” How anecdotal experience does impact on our clinical practice Following up those who survive as patients in the ICU (and their families too) can help prevent a series of future problems The value of eye contact, listening, deliberate use of words and pauses in good communication Peter’s change in thinking about shift handover after reading a paper 10 years ago How talking to families is the highlight of his job The value he sees in sailing yachts to help mind, body and soul His thoughts on aging and working as an intensivist Some vital tips for the less experienced My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to adopt improved habits and behaviours at work, so you can more masterfully interact with and care for your patients, their families and your colleagues. Thanks for joining me on a quest to improve outcomes both in your intensive care and in mine. 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 or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at [email protected]. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   -------------------- Show notes (people, organisations, resources or links mentioned in the episode) MANIC Course: https://www.baxterprofessional.com.au/manic/ Princess Alexandra Hospital: https://metrosouth.health.qld.gov.au/princess-alexandra-hospital University of Queensland: https://www.uq.edu.au/ Monash University: https://www.monash.edu/ CICM: https://www.cicm.org.au/ ANZCA: http://www.anzca.edu.au/ Intensive Care Foundation: http://www.intensivecarefoundation.org.au/ ANZICS CTG: http://www.anzics.com.au/Pages/CTG/CTG-home.aspx ANZICS/ACCCN annual conference: http://intensivecareasm2017.com.au/ Journal article on “Patient Care, Square-Rigger Sailing, and Safety": https://www.ncbi.nlm.nih.gov/pubmed/18840843 Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

What are the biggest challenges when beginning as a fully-fledged intensive care clinician? How do you best use your senior colleagues when your experience bank is still small? What can you do to help achieve gender equity in intensive care medicine?   These are some of the questions you’ll ponder as you listen to the latest Mastering Intensive Care podcast guest Dr Sarah Yong from Melbourne. Having started off 2018 with two “Best of 2017” episodes on the podcast, today allows you the opportunity to hear a new interview. I am enthusiastic and passionate about bringing you some further valuable perspectives on improving how we do our jobs in intensive care units around the world. And this year I’m hoping to branch out a bit and try some new things and some new types of guests. Mastering Intensive Care is not just about interviewing older and experienced intensivists. It’s also about hearing some of the challenges from less experienced intensivists as they traverse the early days of their careers. So in this episode you’ll hear from Sarah who is right in the middle of this phase working at the Alfred Hospital in Melbourne, Australia. After graduating from The University of Melbourne, she completed training in general medicine before obtaining her fellowship of intensive care medicine. Along with critical care, she has a strong interest in education, simulation and the free open-access medical education (FOAMed) revolution. She is currently completing a Masters in Clinical Education in non-technical skills in intensive care. Sarah is a strong advocate for her peers including convening the Victorian Primary Exam Course, chairing the Trainee Committee and being the New Fellows' Representative for the College of Intensive Care Medicine here in Australia and New Zealand. She is a founding convenor of the Women in Intensive Care Medicine Network, which is dedicated to improving the gender balance in Australasian Intensive Care Medicine through advocacy, research and networking. I really enjoyed talking with Sarah. She is eloquent, mature, humble and honest; and she has a great perspective on how we can all take action to achieve improved gender balance in intensive care. In the episode we talk about many things, including: What attracted Sarah to intensive care The rewards of delivering end of life conversations Whether she can sustain a lifelong career in the specialty How she dealt with the transition between trainee and fully fledged specialist Her utilization of other colleagues to support her ever-improving experience base The characteristics of the senior specialists who stood out to her What habits she is concentrating on to develop professionally How she has learnt and developed her communication skills Her excellent approach to a family conversation Dealing with the demands of an intensive care career Preparing at home for a busy clinical week Blending family and career The main gender-related issues women face in intensive care Sarah’s work with the Women In Intensive Care network Her advice for current trainees My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to adopt improved habits and behaviours at work, so you can more masterfully interact with and care for your patients, their families and your colleagues. Thanks for joining me on a quest to improve outcomes both in your intensive care and in mine. 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 or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at [email protected]. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   Show notes (people, organisations, resources or links mentioned in the episode): CICM: https://www.cicm.org.au/ Sarah Yong on Twitter: @drsarahyong Women In Intensive Care Medicine Network: http://www.womenintensive.org/ Women In Intensive Care Medicine Network on Twitter: @womenintensive Women In Intensive Care Medicine Network on Facebook: womenintensive Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

A year ago there was no such thing as the Mastering Intensive Care podcast. Now there are 21 separate interviews, each of which have helped me and seem to have helped many of you to make improvements at delivering more compassionate, thoughtful and patient-centred intensive care. Without fail my guests throughout 2017 were excellent and I really enjoyed doing the interviews. And I promise to bring you the best content I can over 2018 too. Here are the final five of the best 2017 guests, to follow on from the first five in the last episode. This has been difficult as I have seriously enjoyed every one of my guests. I will upset some guests by not including them and I will upset some of you for not including your favourite guest. But nevertheless I have taken the five most downloaded episodes and mixed them with the five I enjoyed the most. Then I took what I considered the best excerpt of the conversation and put them in no particular order over two episodes. So enjoy listening to the best excerpts of the best episodes over the first year of Mastering Intensive Care. I hope it will inspire you to a fresh start in 2018 with some great perspectives for bringing your best self to work. If you’ve missed a few episodes over the year here is a chance to catch up with them and if you are totally new to the podcast here is a glimpse of what Mastering Intensive Care is all about.   Andrew Davies   -----------------   Resources from people, organisations and things mentioned in this episode: MIC Episode 9 with John Myburgh: http://masteringintensivecare.libsyn.com/episode-9-john-myburgh-the-importance-of-the-intensive-care-clinical-ward-round   MIC Episode 12 with Julia Wendon: http://masteringintensivecare.libsyn.com/episode-12-julia-wendon-making-the-patient-the-centre-of-everything   MIC Episode 20 with Jack Iwashyna: http://masteringintensivecare.libsyn.com/episode-20-jack-iwashyna-icu-adventure-camp-time-limited-life-support-trials-and-regular-talks-with-families-dassmacc-special-episode   MIC Episode 10 with Imogen Mitchell: http://masteringintensivecare.libsyn.com/episode-10-imogen-mitchell-an-intensivist-and-dean-of-medicine-focused-on-communication-and-clinical-decision-making   MIC Episode 2 with John Botha: http://masteringintensivecare.libsyn.com/episode-2-john-botha-exemplary-leadership-in-the-icu   Mastering Intensive Care podcast on Libsyn: http://masteringintensivecare.libsyn.com/   Mastering Intensive Care podcast on Life In The Fast Lane: https://lifeinthefastlane.com/?s=mastering+intensive+care   Mastering Intensive Care on Facebook: https://www.facebook.com/masteringintensivecare/   Andrew Davies on Twitter: @andrewdavies66   Email Andrew Davies: [email protected]

A year ago there was no such thing as the Mastering Intensive Care podcast. Now there are 22 episodes with 21 separate interviews, each of which have helped me and seem to have helped many of you to make improvements at delivering more compassionate, thoughtful and patient-centred intensive care. Without fail my guests throughout 2017 were excellent and I really enjoyed doing the interviews. And I promise to bring you the best content I can over 2018 too. Given the Christmas/New Year break is a time for reflection, I thought this was the time to slow down and relive the best of what was heard on Mastering Intensive Care in 2017. Here are the first five of the best 2017 guests, with a further five to follow next episode. This has been difficult as I have seriously enjoyed every one of my guests. I will upset some guests by not including them and I will upset some of you for not including your favourite guest. But nevertheless I have taken the five most downloaded episodes and mixed them with the five I enjoyed the most. Then I took what I considered the best excerpt of the conversation and put them in no particular order over two episodes. So enjoy listening to the best excerpts of the best episodes over the first year of Mastering Intensive Care. I hope it will inspire you to a fresh start in 2018 with some great perspectives for bringing your best self to work. If you’ve missed a few episodes over the year here is a chance to catch up with them and if you are totally new to the podcast here is a glimpse of what Mastering Intensive Care is all about.   Andrew Davies   -----------------   Resources from people, organisations and things mentioned in this episode: MIC Episode 3 with Rinaldo Bellomo: http://masteringintensivecare.libsyn.com/episode-3-rinaldo-bellomo-compassionate-care-with-continuous-enquiry   MIC Episode 8 with Dianne Stephens: http://masteringintensivecare.libsyn.com/episode-8-dianne-stephens-developing-a-happy-work-environment-by-respecting-and-valuing-everyone-in-the-intensive-care-team   MIC Episode 4 with Neil Orford: http://masteringintensivecare.libsyn.com/episode-4-neil-orford-seeking-optimal-communication-leadership-and-balance   MIC Episode 13 with Sara Gray: http://masteringintensivecare.libsyn.com/episode-13-sara-gray-voices-in-my-head-dassmacc-special-episode   MIC Episode 21 with Martin Bromiley: http://masteringintensivecare.libsyn.com/episode-21-martin-bromiley-turning-tragedy-into-safer-healthcare-by-attention-to-human-factors-dassmacc-special-episode   Rich Roll podcast: http://www.richroll.com/category/podcast/   Mastering Intensive Care podcast on Libsyn: http://masteringintensivecare.libsyn.com/   Mastering Intensive Care podcast on Life In The Fast Lane: https://lifeinthefastlane.com/?s=mastering+intensive+care   Mastering Intensive Care on Facebook: https://www.facebook.com/masteringintensivecare/   Andrew Davies on Twitter: @andrewdavies66   Email Andrew Davies: [email protected]

This week’s Mastering Intensive Care podcast features Dr Felicity Hawker who is one of the true female pioneers of Intensive Care in Australia and New Zealand. I had the privilege of working with Felicity for over a decade from when I began as a brand new intensive care consultant over 20 years ago and I came to admire her greatly. Mainly because I witnessed first hand someone who was a master clinician – astute, careful, diligent, systematic, thoughtful, compassionate and knowledgeable. Felicity always handed over the patients in a considered and packaged patient-focused manner. She was a pleasure to work with and I learnt so much from such a high quality role model. Felicity grew up and went to medical school in the Australian state of Tasmania, before completing specialist training in Melbourne, Glasgow and Sydney. She became the Co-director of the ICU at Royal Prince Alfred Hospital in 1985 before moving to Melbourne to be the Director of the Cabrini Hospital ICU from 1995 until 2008, during which time she also worked as a part time intensive care specialist at the Alfred Hospital. She continues to work at Cabrini as the Chair of the Deteriorating Patient Committee. None of this spells out well enough that in the late 1970s and early 1980s, when Felicity was doing her specialist training, intensive care was an almost totally male-dominated specialty (certainly in Australia and New Zealand). Many more women have joined her and us over the years but surely the path she forged can’t have been easy. Nevertheless, Felicity has published extensively, written a book on the liver in critical illness, spoken at many scientific meetings and been highly respected in our community. Felicity’s other major contribution has been her committee work at every level of education and training in the various Australian and New Zealand intensive care training institutions since the early 1990s. With other colleagues she was instrumental in bringing together the anaesthetic and the physician training programs through several iterations to ultimately become what is now a stand-alone College of Intensive Care Medicine (CICM), and where she is now the Director of Professional Affairs. Felicity was the inaugural Dean of the then Joint Faculty of Intensive Care Medicine (JFICM) from 2000-2002 and was awarded the JFICM medal in 2009. Since 2005 she has been honoured with the annual presentation of the prestigious Felicity Hawker Medal to the best research presentation by a trainee at the Annual Scientific Meeting of the CICM. I am extremely grateful to have had the opportunity to talk with Felicity, as in my eyes she has been a brilliant clinician at the bedside, a female pioneer in our specialty and a person who has strived to ensure proficient, knowledgeable and professional intensive care specialists are developed over the course of specialty training in Australia and New Zealand. In the episode we talk about many things, including: The early course of her career and what attracted her to intensive care The enjoyable relationships she has made with intensive care trainees The importance of diagnosis and the need to remain curious and sceptical Her time spent training in Glasgow as a Shock Team registrar The influence of a dynamic female consultant during her own training How attitudes and outcomes have changed since when she was one of 2 consultants at what is now one of the biggest ICUs in Sydney The characteristics she thinks good intensivists require Communicating with colleagues and patient’s families Her highly valuable published survey of the issues female intensivists face How research has changed since her early career Her views on winding down an active intensive care career Her earlier successful horse riding career Her current role as a doctor at professional horse racing meetings How she has dealt with the stress of an intensive care career Her observation that many intensivists want to be educationalists Her enjoyment of family, cryptic crosswords, reading and travel And some valuable advice to 35 year old intensive care doctors This podcast is 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, our fellow healthcare professionals and indeed ourselves so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at [email protected]. Thanks for listening. Please do the very best you can for your patients. Andrew Davies     Show notes (people, organisations, resources or links mentioned in the episode) CICM: https://www.cicm.org.au/ CICM honours: https://www.cicm.org.au/About/Honours-Awards Felicity Hawker medal: https://www.cicm.org.au/Trainees/Assessments-and-Examinations/Formal-Projects#FelicityHawkerMedal Published paper on survey of female specialists in intensive care medicine: https://www.ncbi.nlm.nih.gov/pubmed/27242111 Felicity Hawker on LinkedIn: https://www.linkedin.com/in/felicity-hawker-728a3025/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

Are we truly making healthcare safer? Do we adequately understand human factors in how we work in hospitals? How would you respond if your partner died from a “routine operation”?   These are just 3 of the questions you are likely to ponder as you listen to this interview with Martin Bromiley OBE from the United Kingdom on the Mastering Intensive Care podcast. Whilst many people that we care for in our Intensive Care Units receive excellent care, sadly there are some who end up in our ICUs after something goes unexpectedly wrong during a routine operation. Tragically some of these people die. Not due to anything they did, but from medical error. In the final DasSMACC special episode, I speak to Martin Bromiley, who became a widower when his wife, Elaine, died in such circumstances 12 years ago. In what has been described as “the direct result of human factors and failings in non-technical skills, created by systemic failings in the healthcare system”. Martin didn’t blame, shame or complain. He did his best to move forward by researching the culture in healthcare around safety and human factors. And he recognised that although there were pockets of excellence the UK’s National Health Service was culturally a long way behind most other high risk industries. As a result of his experiences Martin supported the making of a DVD entitled “Just a routine operation” which explored the lessons of his late wife’s death, as well as a BBC Horizon programme about human factors called "How to avoid mistakes in surgery". Professionally Martin works in aviation where he is a pilot for a major UK airline and where he has a background specialising in human factors. Therefore, Martin founded the Clinical Human Factors Group, a non profit-making charitable trust which aims to advise and promote best practice around human factors. Since then the Group has promoted human factors at the highest levels in healthcare, making a significant contribution to current thinking. More significantly though, the terms human factors and system safety are becoming much more commonly understood in healthcare, much of which is due to Martin’s efforts and leadership. His work has been recognised through awards from the Royal College of Anaesthetists, the Difficult Airway Society, and the patient support group “Action Against Medical Accidents”. In the 2016 New Year Honours list Martin was awarded an OBE for his work to further patient safety. Martin was a speaker at the DasSMACC conference in Berlin back in June, and after delivering an enthralling talk entitled “How To Fail”, we went to a quiet room to record an interview. We had an important conversation and touched on: The tragic case of Elaine and her death after a routine operation How Martin dealt with it What support Martin received in and out of the hospital What Martin has been doing to try to improve safety in healthcare What healthcare can and cannot learn from the aviation industry His 3 key messages about human factors How he uses mental rehearsal to be the best airline pilot he can be This podcast is 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. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at [email protected]. Please also consider making a donation to the Clinical Human Factors Group here. Thanks for listening. Please do the very best you can for your patients.   Andrew Davies   --------------------   Links related to Martin Bromiley Martin Bromiley Martin Bromiley on Twitter: @MartinBromiley Martin Bromiley on LinkedIn Clinical Human Factors Group Donations to Clinical Human Factors Group Video “Just a routine operation” Video “How to Fail…Part Two” (a talk by Martin Bromiley at DasSMACC conference) Video “Martin Bromiley, a Patient’s Perspective” (talk by Martin Bromiley at Patient Safety Movement) Anonymous version of an Independent Report on the death of Elaine Bromiley Article “The husbands story: from tragedy to learning and action” (authored by Martin Bromiley) Article "Clinical Human Factors" (co-authored by Martin Bromiley) Article 1 on Martin Bromiley Article 2 on Martin Bromiley Article 3 on Martin Bromiley Article “Lessons from the Bromiley Case” (by Mike Cadogan on Life In The Fast Lane)   Links to other resources (in order of mentioning) SMACC TED Book “Black Box Thinking” (by Matthew Syed) Paper on the Safety 1 and Safety 2 model Second paper on the Safety 1 and Safety 2 model Third article on the Safety 1 and Safety 2 model Jim Harlow on Twitter   Links related to Mastering Intensive Care 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 Andrew Davies on LinkedIn Email Andrew Davies

Do you play the role of the exemplary leader in the ICU? Are you charming, funny, friendly and extroverted – even when these aren’t your natural personality characteristics? Do you throw yourself into your series of consecutive days in the ICU like you are going away to adventure camp? Do you outline specific objectives that a patient should meet over a timeframe of a few days to decide whether treatment should continue? And how regularly do you talk to your patient’s family when you are pretty sure the patient is dying? These are some of the questions you may ask yourself after listening to this episode of the Mastering Intensive Care podcast with American intensivist Jack Iwashyna. This is the fifth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Jack is Associate Professor of Pulmonary and Critical Care Medicine at the University of Michigan where he is a practicing medical intensivist at both the University of Michigan and the VA Ann Arbor Health System. He also devotes significant energy to training clinician scientists and is best known for his work defining the concept of “survivorship” after ICU and measuring aspects of the post-intensive care syndrome. Jack’s keynote talk at DasSMACC was entitled “Persistent Critical Illness” and as you’ll hear in this podcast he is the perfect person to talk about this given he does 14 day blocks in his ICU allowing him ample opportunity to understand what happens in the evolution of a patient’s critical illness. Despite Jack self-proclaiming he is introverted, this episode of the podcast reveals him to be a diverse conversationalist with well-matured thoughts, views and reflections on his own experience about how a consultant intensivist should act, whether that be in throwing ourselves 100% into our clinical service, playing a specifically crafted leader’s role, wisely mentoring less experienced clinicians, regularly communicating to patient’s families, simply having fun doing our job with our colleagues and respecting our spouses and families for supporting the work that we do. We cover a myriad of topics including: Jack’s powerful answer as to why he loves his job How invigorating it can be to talk to people he has only just met How he has previously done 30 day stretches of continual clinical service As a researcher he tries not to study his own ICUs too closely Our fixation on short-term survival is inadequate for most patient families His use and the benefits of time-limited trials of life support How he uses a school-like A-F range grading to mark patient’s progress The benefits of taking his children away on academic trips His somewhat raw reflections about not feeling as good a father and husband as he is a doctor The difference between mentoring in research and in clinical practice Our role is to try to help all trainees to improve, however good we perceive them to be Burnout is a systems issue – where the system is being run too hard The importance of sleep and afternoon naps This podcast is 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. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at [email protected]. Thanks for listening. Please do the very best you can for your patients. Andrew Davies   Show notes (people, organisations, resources or links mentioned in the episode): Jack Iwashyna at University of Michigan: http://ihpi.umich.edu/our-experts/tiwashyn Jack Iwashyna on Twitter: @iwashyna DasSMACC: www.smacc.net.au

Are you receiving elderly intubated patients where someone else says they want “everything” done? Are the doctors who refer patients to intensive care finding out what their patients really want towards the end of life? Does this frustrate you on a daily basis?   This is a huge topic in intensive care. Finding out the wishes of our patients before they end up on a ventilator with no one to speak for them is vital if we wish to deliver optimal healthcare. Yet so often we intensivists are left to deal with this situation. And whilst in most cases we do this very well, many of us like Dr Alex Psirides, a UK, New Zealand and Australian-trained intensivist, feel the despair as we hold another lengthy meeting with a patient’s family. In this episode I spoke with Alex about this topic, which he had just delivered a brilliant TED-like talk on at the DasSMACC international conference in June. Alex has a great perspective to share as two of his specific clinical interests are managing dying patients and rapid response systems for deteriorating patients. This is the fourth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Alex is an Intensive Care specialist at Wellington Regional Hospital in Wellington, New Zealand. His work and research in the area of rapid response systems has led to an appointment as the clinical lead for the New Zealand Health Quality & Safety Commission’s 5-year national ‘Deteriorating Patient’ programme. He is also the clinical lead for Wellington’s aeromedical retrieval service, which covers the lower North and upper South Islands of New Zealand. In his spare time, when not walking his dog or children, he builds websites & designs logos for Wellington ICU’s prodigious research department, as well as sending a few tweets via Twitter handle @psirides. Given Alex has been an ICU consultant for less time than most of my other guests, I had to talk him into doing an interview, but I’m really glad he agreed. There is so much to like about this conversation. Alex is honest and humble enough to say he’s not so sure he’s that good at predicting patient outcomes, at least in neurosurgical patients, which is the precise reason he has something to teach us on the podcast. We also cover topics including: Why Alex loves intensive care (with a great answer) How his consultant team work so cohesively The need to respect co-worker’s opinions and to avoid tribalism How a team of intensivists meeting with a team of neurosurgeons away from the patients can make practice more consistent and evidence-based How his team uses simulation to reduce rudeness and lack of respect How efficiently his hospital ran when there was a 3 day doctors strike A good ward round requires asking for and addressing the nurse’s concerns but also finishes with a clear plan to move the patient forwards Bringing his best self to work requires feeling loved at home and having a great team to work with Some of the non-textbook medical books Alex has been enjoying reading Hobbies allow him to escape from work and to use his creativity How far away he feels right now from burnout What he can get better at over the next 5 years How palliative care physicians can be helpful in teaching us and our trainees about end of life discussions This podcast is 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. Please help me to spread the word by simply emailing your colleagues or posting on social media. Feel free to leave a comment or a question. I hope we can build community through Mastering Intensive Care so colleagues can share their thoughts and tell us how they are mastering their own skills. Leave a comment on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at [email protected]. Thanks for listening. Please do the very best you can for your patients. Andrew Davies     Show notes (people, organisations, resources or links mentioned in the episode): Wellington Intensive Care medical team: http://www.wellingtonicu.com/AboutUs/Staff/SMO/ DasSMACC: www.smacc.net.au Alex Psirides talk on “Doing everything at end of life”: http://wellingtonicu.com/Data/Doing%20Everything%20DasSMACC.pdf Book “Being Mortal” by Atul Gawande: http://atulgawande.com/book/being-mortal/ Book “Do No Harm” by Henry Marsh: https://henrymarshdonoharm.wordpress.com/reviews/ Alex Psirides on Twitter: @psirides

Are your ICU patients ever in a holding pattern? Do you aim to liberate your patients from ICU as soon as possible? Is your caution about moving things forward harmful to our patients?   I don’t think we talk often enough about the dangers of conservatism in intensive care. About how if we are cautious in thinking the patient is not quite ready to be extubated, or have the sedation turned off, or stop the antibiotics, then we sometimes don’t realize the harm our inaction may cause. A topic you will enjoy hearing about in this interview with Professor John Marshall on the Mastering Intensive Care podcast. John is a Professor of Surgery at the University of Toronto, and a trauma surgeon and intensivist at St. Michael’s Hospital in Toronto, Canada. John has an active clinical research interest in sepsis and ICU-acquired infection, and in the design of clinical trials and outcome measures. He has published more than 325 manuscripts, and 85 book chapters, and is the editor of 2 books. He is the founding chair of the International Forum of Acute Care Trialists (InFACT) – a global network of investigator-led critical care clinical research groups, he is Secretary-General of the World Federation of Societies of Intensive and Critical Care Medicine, and vice-chair of the International Severe Acute Respiratory and Emerging Infections Consortium.  He is also past-chair of the International Sepsis Forum, past-President of the Surgical Infection Society, and past-chair of the Canadian Critical Care Trials Group. He has given invited lectures at more than 470 meetings around the world, is a member of seven journal editorial boards, and an Associate Editor of Critical Care Medicine and Critical Care. In this conversation we also cover topics including: Being both a surgeon and an intensivist – and why ICU might be more fun Humility and curiosity as the two most important habits for intensivists That surgeons seem to own their complications more than intensivists The benefits of family member presence on the ICU ward round Why we should question everything we do in a provocative dialogue How research helps us at the bedside The value of collaborative research networks The observations that some ICUs can feel joyless Withdrawing interventions may not always lead to death The time when John was involved in a 4 hour CPR If we can’t define what an intervention can or cannot do, perhaps we shouldn’t do it The privilege John feelsto be able to make mistakes that might cost people their lives His artistic pursuits outside of medicine (including the story of a rock band) The constant feeling of rejection in academia The skills required to give a good talk How developing academic capital might be the best way to get a job 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 [email protected] or engage in the facebook page Mastering Intensive Care. Thanks for listening. Please go out and do the best you can for your patients. Andrew Davies

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 [email protected] 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 [email protected] 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 [email protected].   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 [email protected], 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 [email protected], 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 [email protected], 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 [email protected].

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 [email protected].

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 [email protected].

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 [email protected].

Assoc Prof Charlie Corke from Geelong, Australia outlines the importance of optimal communication in helping us arrive at the best decisions for our patients. Charlie is one of Australia’s leading intensivists and has been teaching communication and high quality end of life decision-making since before it was even fashionable. Charlie reflects on how we can communicate effectively, telling us that communication begins with caring, requires deep respect for others, is mostly about addressing the needs of others, and most importantly involves finding out what the patient truly wants. In a wide-ranging interview, Charlie tells us that intensive care is not a place we can “mess up”, that good intensivists are like the Sherlock Holmes of the hospital, that delegation of authority can never be vague, that we need to look after our selves as well as we do others, how bullying can be so counterproductive, and how much better it is to work in an intensive care unit which favours consistency of practice over individual opinion-based attitudes. Charlie muses on the fact that we need both good leaders and good followers in our intensive care teams to deliver the best outcomes for our patients. The interview concludes with Charlie telling us that sometimes when it all gets too much the best thing to do is to walk out of the intensive care unit or the hospital, have a colleague take over, and to take some time out before coming back to work. He also rejoices in the benefits of working part time. 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.

In this episode Assoc Prof Craig French from Western Health (where he is Director of Intensive Care) and Melbourne University in Melbourne, Australia reflects thoughtfully about many aspects of clinical care including how inspiring a healthy workplace culture can lead to staff enjoyment as well as improved patient outcomes. Craig discusses topics such as: how in intensive care we have become more focused on less is best and that this may lead to clinicians becoming deskilled, how good communication and listening requires not being afraid of silence, the benefits of doing a pre-ward round ward round for planning the flow of the day, how more frequent handovers can be an issue, that we are probably moving towards 24 hourly hospital-located intensivists (which may help work-life balance), engaging well with nursing staff is vital including providing them with clear aims, simple observation of patients and their surroundings can provide an enormous amount of information, ward rounds can’t go too long and they need to have some sort of predictable order for the effective running of the ICU, the massive importance of having a life outside of medicine, his own competitive cycling career, his use of Tibetan meditation to deal with his pathological fear of flying, how busy clinical days can lead to skipped meals and eating fast foods, and how he worries about whether he is spending enough time with his wife and family. The interview concludes with some thoughts from Craig about the issues with working at home in the evenings, some of the principles of good end of life care, how inspiring a workplace culture which fosters everyone achieving their best can help both staff morale and patient outcomes, and how CPR in the community for elderly patients might be considered futile even before the patient arrives at hospital. 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.

In this episode Prof Jamie Cooper from the Alfred Hospital and Monash University in Melbourne, Australia describes how purposeful management of our own careers is vital for longevity in the field, how research has helped him be a better clinician and some of the habits he thinks are important to having a good life at work and at home. Jamie discusses topics such as: why he the immediacy in ICU made it interesting to him; how as a trainee his older colleagues were warning him about burnout; how the size of ICUs has changed over his career; how the gender imbalance has not; how combining research with clinical medicine has increased his career longevity; how if everyone in a department helps each other, the place will be happier; how ICUs can become too large for a single department head; how caring for multiple patient types extends our career; how building too many things into our lives especially at work is a big risk; how preserving evenings and weekends for family is a must; the importance of regular exercise, especially with groups; how important sleep including naps has been to him; the benefits of bringing reading back into his life; the value of communication, especially with visiting surgeons, where conflict may arise; how the use of text messages can be very helpful and when it is not. The interview concludes with some advice from Jamie for younger intensivists about how they should be alert and aware to prevent potential troubles in their careers. Jamie has had a hugely successful academic career, however quite rightly he hopes to be thought more of for his excellence as a clinician, something he certainly is. 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 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.

In this episode Assoc Prof Neil Orford from University Hospital Geelong in Geelong, Australia describes how he has had to learn key leadership skills, how he values and now teaches communication skills, how he works on his overall life balance and how he has developed an interest in writing. Neil discusses topics such as: how he ended up studying medicine after considering being a vet and a mathematician; how he uses regular reflection to optimise his life balance, concentrating on understanding the number of major projects he is involved in at any one time; how he needed to find good leadership training once he became an ICU director in his 30s; how important skilled communication is and how he has become involved in a communication program which amongst other things uses professional actors; how communication skills can be used in all areas of life; the key characteristics of good clinicians; how he interacts with other team-members on a ward round; use of mobile phones on ward rounds and how important a regular presence in the ICU is. The interview concludes with a discussion of Neil's interest in writing, how he penned an opinion piece for the local newspaper and how this was received, where he is aiming at with his writing, and how writing gives him some release from the other aspects of his job. Neil guesses that his colleagues would consider him to be a caring leader and after listening to this excellent interview most listeners are likely to agree. 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 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.

In this episode Prof Rinaldo Bellomo from the Austin Hospital in Melbourne, Australia describes how he has always had an enquiring mind and how he judges himself with respect to his ability to be caring, compassionate, competent, communicative and collegial, both professionally and personally. He discusses topics such as: how an experience as a 5th medical student sparked his interest in intensive care medicine; how intensive care has become more safe as technological advancements have occurred; how he seeks feedback from colleagues; how to give feedback and how it needs to be helpful in nature; what his daily routine is; how being at the bedside is so important to excellent clinical care; how experience has helped him deal with stress more easily but makes fatigue a bigger issue; how doing research is the basis of his stress management program; what his out of work pursuits are and how he'd love to have a 30 hour day. He carefully describes the process he uses in his end of life family conversations and astutely points out that end of life care can never be rushed. The interview concludes with Rinaldo's hope that he be known for his continuous desire to ask "how do we know that we know this" at the patient's bedside (which has no doubt fuelled his enormously successful research career) and precisely what he thinks all doctors could do to help them become more humble. This is an outstanding conversation about compassionate clinical care with one of the best intensive care researchers in the world who is also one of the great mentors of our time. 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 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.

In this podcast Prof John Botha from Frankston Hospital in Melbourne, Australia discusses several aspects of exemplary leadership in the ICU. He talks about why he was attracted to ICU; some of his early mentoring; how to learn from even difficult mentors; how an exceptional ICU environment requires trust, a sense of humour and respect for difference in opinion; the importance of encouraging silence in critical clinical moments; the value of listening; the things out of the ICU that keep him from being stressed; the sense of deep connection to humanity he feels from managing the critically ill; what is required for high quality end of life care; and a method for managing other clinicians who may be more proactive with interventions. 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 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.

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 of the following episodes, Andrew Davies, an intensivist in Melbourne, Australia, will speak 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.