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   --------------------</p

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

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 inspi

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. <b

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 wellb

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 th

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 t

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.   --------------------   Releva

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 Me

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

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 tea

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 pod

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 Mont

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 re

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 be

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 a

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 denie

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

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   ------------

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 abou

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 att

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 <

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)

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 s

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 wi

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 presentation

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 Univ

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

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 sens

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

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

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. <

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 b

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 Int

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 pr

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 h

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 Fellowshi

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 t

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 includin

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 he

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, Intensi

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 storie

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 benefit

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 intensiv

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 me

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

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

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

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 surfi

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

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

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 s

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 obvi

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 i

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, bot

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 sc

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 kno

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 Car

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 ESI

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 developin

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 Glo

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

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

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

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

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

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 f

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 systemi

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 o

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 ma

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 chapter

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 findin

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

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 Medi

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 i

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,

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

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

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

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 lif

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

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 consi

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 rou

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 mus

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

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 fa

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, Andr

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.