Dear doctors, be kind to each other.

Kindness is Key!

This blog post by Dharmaraj Karthikesan is like pure gold – laden with courageous statements that ooze of wisdom! (like the one quoted below) thanks Dharmaraj 🙂

The health profession needs more docs like you!

“We often excuse doctors who are bullies because they are ‘great with patients’ and are ‘brilliant clinicians’ or ‘gifted surgeons’. This hurts the profession more than you can imagine.”

read on ….

Dharmaraj Karthikesan's Blog

I met a young doctor who used to work under me recently. I had just completed my night rounds in the hospital and I was leaving for home.

And then I saw him. He was unkempt, exhausted and appeared famished. Worst of all, he looked like a man who has totally given up on being a doctor. He appeared hesitant when I asked him what was wrong, but I could not just leave him there.

After much persuasion and insistence on my part he agreed to join me for a late supper. While he ravaged through his first proper meal of the day, he finally opened up. He has started working for the past week in a new speciality. Though the hours are longer, it was not an issue. He was well aware of the sacrifices he was expected to make.

However, the degradation, humiliation and constant harassment have finally taken…

View original post 1,731 more words

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Emergency medicine, and the loophole of love!

the loophole of love

With love we rise above,
Like the angel to the dove,
That flies high in the sky,

Above the the question of “why?”,
This should happen, or that should happen,
Instead taking “acceptance” as the key,

For only then will we be free,
From the visitudes of life,
For these are the ones that give it the spice,

Like a curry to its rice,
Remembering that there is no price,
In dreaming away,

So forget what “they” might say,
Because inside we can continue to pray,
For the gift of smiling yet another day,

And loving the present moment,

For in the end,
It’s all we have.

9-5-15

I recently started a new rotation of Emergency Medicine training, and before long have found myself immersed in all it’s beauty and simultaneous horror. Our speciality is full of energy, love and frustration. There are good days and challenging days, magic moments and equally frustrating ones, often intertwined into the same 10 hour shift, if not the same hour.

Most days are heavily mixed with both energies which makes it hard to have a frame of reference for an answer when someone from outside this world asks, “so how was your shift?”. For me, it is perhaps most truthful to answer this question with a guitar in hand. An example of this is provided with the the song titled “in the night drift”, that I have included at the end of this post.

Often the pressures within a single shift are high, but when compounded within a persons training period, or across sections of their career span, it is understandable that a soul searching doubt can easily set in, to the point where the question of “why am I doing this again?” is asked.

I am sure that this question gets asked by many in the field, perhaps with haunting frequency, regardless of whether one is a nurse, doctor or any of the multitude of other health “carers”.

Doctors, nurses, and the many other important ones

Whilst most would argue that “doctors and nurses” are at the core of health care provision, there is an array of other people, who occupy either named professions or unnamed roles. These people often contribute under the radar of recognition, but are making a huge difference in the field of emergency medicine everyday.

The list, in no particular order, includes but is not limited to;- physiotherapists, radiographers, clerical staff, nurse aids, cleaners, porters, special care assistants, pharmacists, translators, administrators, radiographers, laboratory staff, parking attendants, building engineers, ambulance and police staff, public health workers, aged care workers, counsellors and social workers, and not least the patients themselves and their families. We are all one, interacting together, in the common milieu of a single shift on the emergency medicine shop floor (a term that is often used to encompass the Emergency Department by Emergency Physicians in Australasia).

Why we practice emergency medicine?

Regardless of whether one is a doctor or has one of the many other important roles in this arena, perhaps Mel Helbert puts forward one of the best expositions of why someone would consider undertaking a career in emergency medicine in his recent talk titled from the EM essentials conference titled “why we practice emergency medicine”.

Mel, is the creator/founder of the EM Rap education channel, is a champion in emergency medicine education. When I use this term I mean it both literally, but I also mean to use it as a term from the field of “knowledge translation“, used to describe those who are proponents of change, in the evolving culture of crossing the “know-do” gap.

Whilst everyone’s story is interesting in their own unique way, Mel seems to have captured with his unashamedly honest exposition something that reaches out and inspires his audience, no matter if you love it or hate it, are within or outside the profession, or are simply curious about why anyone would want to do this job.

It was a really interesting 15 mins so I thought I’d share it here – thanks Mel!

The night shift

 
As promised, this is a song called “in the night drift” that I recorded directly after surviving busy nightshift, when I crawled back to my hospital accommodation and had a much needed sleep (albeit after a date with my guitar!). Enjoy 🙂

A PhD thesis in knowledge translation: Improving medical management through research and training

When I tell people that I have been doing clinical research for the better part of my last decade of life I usually get a few or more of the standard questions that are asked of higher degree research students like, “what did you do your PhD on?”, “what did you find?”, “was it hard?”, “why did you do it?”, and “what’s next?”.

These questions can be asked in a matter of seconds, but to answer them even briefly can take from 15 minutes to hours, depending on the level of interest. Now that the PhD is finally wrapped up, I feel inspired to write down some of the answers to these questions. I write in the spirit of what my thesis was all about “knowledge translation”, in other words, getting research off the shelves and into practice.

What was your PhD thesis on?

The title was “Improving the medical management of organophosphorus poisoning (OP) throught health services research and training”. Self harm is a big problem worldwide, and anyone working in an emergency department will be no stranger to this problem whether it is from people cutting themselves or taking overdoses. In many parts of rural Asia people drink pestices as a means of self harm resulting in over 300,000 deaths annually.

The vast majority of these pesticides are a particular form called organophosphate agents. This is much more toxic that the common weed killers used in Australia, such as round-up which is a glyphosate, and organophosphorus agents result in high case fatality rates, in the order of 15-30%, despite best practice.

The research collaboration that I worked with to conduct my research, the South Asian Clinical Toxicology Research Collaboration (www.sactrc.com), was a project that aimed to address many aspect of the public health problem of pesticide self-poisoning.

My work focussed specificially on two areas;

1) Improved medical management through the use of point-of-care tests that could provide information (acetylcholinesterase, ACHE, levels) that was thought to be useful in guiding antidote therapy
2) The evaluation of a train-the-trainer system of education to address training deficits in resuscitation education in the rural Sri Lankan setting

Both of these streams of study were different vehicles on the same journey of aiming to close the knowledge practice gap surrounding the management of OP poisoning. Thus the overall theme of my thesis was to do with this process of “knowledge translation”. The studies have been liked together using this conceptual framework.

They say a picture says a 1000 words so perhaps a figure from the introduction section of the thesis of the conceptual frame work , and two figures from the conclusions sections would aid to this strategy (ie 3000 words!?)

fig1

fig2

fig 3

Was it hard? Why did you do it?

These two questions are perhaps best answered together.

Yes it was hard.

I did it for multiple reasons, but most of all, it was the journey of trying to make a difference in the world. I have always wanted to do this, and when I started doing educational research I realised that there is an immense potential to improve the world by creating, and then assessing different systems of education.

The following video/slideshow shows how this happened in a poetic format.

The course of the PhD offered many challenges for my Emergency Medicine training that I was doing concurrently, as well as the ups and downs of life.

However, despite the knocks and triumphs, I strengthened my resolved to follow the dream I initially had with making a difference through training in Emergency Medicine training and International Research, and so far it has paid off in ways that I cound’t have imagined.

What’s next?

The first step was to stop, appreciated, and then reflect upon lessons learned, and wisdom gained that will hopefully help myself and other in the future. The next step is to become an Emergency Medicine consultant by finishing off the training, through training and sitting a fellowshop exam next year in 2016.

As for the future, I have some dreams and visions. I would like to continue as a clinical academic, teaching medical students and junior doctors. The vision I have is to help address many challenges in health care training, by fostering better “systems of training and education”. Perhaps one way this could be done is through research that also takes into account the important human factors of communcation and compassion, but who knows – tomorrow is still a mystery?

Some key publications;

The Effectiveness of a ‘Train the Trainer’ Model of Resuscitation Education for Rural Peripheral Hospital Doctors in Sri Lanka – Plos One (2013)

Evaluation of the Test-mate ChE (Cholinesterase) Field Kit in Acute Organophosphorus Poisoning – Annals of Emergency Medicine (2011)

Effect of acetylcholinesterase (AChE) point-of-care testing in OP poisoning on knowledge, attitudes and practices of treating physicians in Sri Lanka (2014)

PDF of Thesis

Current research projects;

Enhancing employee engagement and wellbeing in at risk units