#SmaccDUB – critical care and beyond…

I recently returned from a 4 day convention titled “smaccDUB”, the conference otherwise known as “social media in critical care”, this year held in Dublin, Ireland. The conference stayed true to its founding virtues of learning, education and innovation in pursuit of excellence within critical care. Smacc is also the ideological meeting place for all those passionate about promoting “free open access meducation” (a.k.a. #FOAMed) as a means of disseminating and translating knowledge to improve the world of medicine. However, for me this years conference had something a little extra within it, something rather special. The opening laser ceremony touted the themes of exploration, connection, and inspiration and by the end of the conference I couldn’t help but feel this was exactly where we had journeyed. I hope to share some of the reasons why I felt this way through the musings of this blog post.

 

Diversity and creativity

SmaccDUB pushed boundaries, moving beyond the diverse range of resuscitation and education themes that I’ve grown enjoy at the 2 previous Smacc conferences I’ve attended. The talks expand further than ever before on the spectrum of leadership, communication, teamwork, and ethics in the critical care.

Many of the talks showed a progression from pure science to the humanities, and even the philosophy of modern health care and science as we know it was repeatedly challenged during the course of the 4 day convention. To this end the use of the current journal system as a means of knowledge creation and dissemination was questioned in an interesting debate. The panel included former BMJ editor, Richard Smith, and the current editor in chief of the New England Journal of medicine, Jeff Drazen, who argued their differing perspectives on the benefits, or shortcomings, of the current peer review system.

Perhaps exploration of this nature, challenging entire paradigms, is called for at this point in history. For anyone who has witnessed the rapid technological advances that health care has seen over the last 20 years, will be forgiven for wondering just where we are going in the future. With the increasing focus on protocol driven investigations and treatments, it was refreshing to note that the conversation amongst the Smacc speakers seemed to continually  bring the focus of conversation back to the “human aspects” of care.

On the other hand, creativity was an equally important theme embraced by the conference, which itself was a highlight for me. It seemed as if fun and creativity, branded by the use of music, lights and live performance, were like the vessels through which the content was delivered. It was as if “science” and “art” seemed to be inextricably linked at every stage. This was particularly evident for me in the pre-conference sessions which included a workshop on creative writing, design and fine art in order to help make educational content more interesting. But it persisted every step of the way, from the rock-concert style opening ceremony, with laser lights display, right up until the final act of the grand finale.

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The additional daily antics that included choreographed ultrasound displays and competitions, and finally interactive debates, making use of rap and rhyme to argue out positions on issues like thrombolysis in submissive PE, was all part of the mix.

 

Mindfulness, leadership and communication

The conference opened with the “John Hinds” plenary, named as such in honour of the individual whose career long contribution will continue to inspire, as much as his loss will be felt amongst this community of critical care workers, following his relatively recent tragic death. In this section, Victoria Brazil (@SocraticEM) kicked off by entertaining us with a high quality role play. She cleverly illustrated to a captive live audience, the potential negative and positive impacts that our everyday communication can have on the quality of education, trainee self-esteem and ones motivation to learn.

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Scott Weingart (@emcrit), of the EM Crit blog, similarly pushed the boundaries of a traditional talk by discussing Vipassana meditation and the role of this practice in his life. He opened minds and hearts by delivering a plenary session on a topic that perhaps has never before been delivered in a conference of this nature. Speaking from direct experience, his talk endorsed the personal and professional values of meditation when looked at entirely from a scientific perspective. Scott likened this practice to a structured “training”, or exercise for the mind – coining the phrase “kettle bells for the brain” to describe what meditation was analogous to in his mind.

To me this was a groundbreaking talk because here was a leader in our field highlighting a practice that is still relatively unfamiliar amongst our medical community, despite its great potential to improve self-awareness, communication and decrease stress. It was also encouraging to see Scott maintain a completely scientific approach, and alerting the audience of the growing  evidence base for mental health and performance benefits following a meditative practice. The benefits of mindfulness is something that I have experienced in my own life, and I thus my encourage whenever I get the opportunity. The talk even included a short demonstration of the practice meditation, and provided a motivating discussion of how the philosophy of mindfulness could potentially help in stressful settings such those that are commonly encountered in emergency medicine and intensive care.

Multiple talks furthered the leadership theme, including those by TEDMed speakers such as Resa Lewiss (@ultrasoundREL), and visionary talks about the future of medicine, by senior clinics such as Simon Carly (@EMManchester) who blogs at St Emlyn’s virtual hospital. Simon provided an insightful back track into the journey that modern medicine has taken over the last 20, and providing an insight into where it is headed. He also provided a live demonstration of an iPhone ECG trace being delivered through a $100 gadget that is easily accessible already – indeed it appears to be brave new world of health care which we are heading towards at great speed!

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War, fear, and love

Building on the theme of mindfulness and self-awareness the conference also included a talk on “fear”, and heart-felt presentations about working in emergency situations of terrorism and war. A wake up call was delivered to our small room audience when Kass Thomas (@KassThomas4) presented recent real life experience of falling victim to US led gunship attacks on the Kunduz Trauma hospital where she was working during her first MSF mission in Afganistan. Her courageous and chilling talk detailed how she survived the ordeal of seeing so many friends, colleagues and patients die in front of eyes on that frightful October night. Her talk in particular highlighted an urgency to address the plight of hospital aid workers across the globe as there continues to be increasing numbers of hospitals suffering the same fate by being targeted under the hospices of war.

The theme of critical care workers experiencing trauma beyond the realms of normal experience was continued in other talks such as that by Christina Hernon (@emedtox)  who was an immediate responder in the Boston Marathon bombing, and Ashley Liebig (@ashleyliebig), who is a flight nurse who recounts a story fo a heart wrenching paediatric field resuscitation. In a similar vein both these speakers courageously revealed the human behind the professional veil.

Through their captivating stories they took us, the audience, into that vulnerable space of humanity, that nobody voluntarily enjoys.  These talks generated a magnitude of interesting discussion both on the twittersphere and in-person discussions amongst other delegates. Perhaps the common theme that was uncovered was a respectful appreciation of the vulnerability that goes with the human side of the critical care, a side that rarely discussed in fast pace of daily business, and I am grateful to these speakers for creating that space.

In keeping with this gloves off approach, nothing was more “on the mark” than the unplugged presentation by Ross Fisher (@ffolliet), a TEDx speaker and Paediatric surgeons who discussed the inward reaching topic of “what scares me”, “what scares you”. In his day 2 plenary session, he challenged the audience, and guided them through recounts of salient challenges in his own professional career, towards taking a long and hard introspective view at our own personal fears.

One of the most memorable experiences for me in that talk was Ross’s request for the audience to join him in a journey of exploring one’s own worst fear. Despite the vast majority of the audience coming from a critical care background where perhaps the intense nature of the job lends itself to forge patterns of adopting a fearless stride we walk, on this occasion, when asked by Ross, whether we could identify our fear and its debilitating nature, I can’t recall a single person who was left seated. “That was fear”, acknowledge by all, and together we stood.

Many other talks that also provided a compelling discourse about other human factors that are often given secondary importance, were covered with vigor and passion, such as the importance of palliative care, bedside teaching and team training, and the topic of physician and trainee burnout.

However, perhaps one other memorable talk that pushed the boundaries, again,was that by the experienced and entertaining social worker, wellbeing specialist, researcher Liz Crowe (@LizCrowe2) who gave the first talk I’ve heard in a critical care conference whose title and focus centred on “LOVE”. With great passion and enthusiasm, and a large dose of wit, Liz delivered a very serious and important message that “love can revolutionise the way we deliver critical care”.

Liz advocated that there is science that supports what mechanistically makes sense, humans have an improved ability of to make good decisions when they work in an environment where they feel supported and cared for, as opposite to when they feel intimidated and stressed. This talk was laden with culture changing gold and I can’t wait it to come out on the smacc video cast so that we can “share the Love” that Liz speaks of!

Dublin, its surroundings and the Socials

Dublin was a wonderful city, that could provide no better a venue that offered history and culture, as well as fun and frivolity that only a Smacc participatory audience could dream of. Daily #smaccPUB, with rotating venues along the old temple bar, along with the grand finale party at the 5 story Guinness storehouse complex, fully equipped with live bands and DJs ranging from house, to rock to Irish folk – not to mention the highly acclaimed FOAMeoke, and few cats who decided to so some street jamming as part of the after party– who could ask for more?!

From physical reality, back to the twittersphere…

So I will end this post with a handful of crafted tweets by the arguably the biggest component of the conference itself, the delegates, speakers and followers both locally and afar. After all perhaps half the magic of this conference is to do with the emphasis that has been placed on audience participation and interact, that arguably no medium does better than 160 summary of words/photo/or link which the average “tweet” offers as a communication tool.

So congratulations if you made it this far in the entry that I started writing on the plane home, as part of the #smaccdown process. I tried to cut it down but there really was so much happened in such a short period of time, a fact that I’m sure those who also attended will attest. There were many other innovative talks that I attended on resuscitation, hospital systems and medical education that unfortunately couldn’t make it into this post, but hopefully some of them can be covered in the tweets below.

It is clear to see that I thoroughly enjoyed this conference, leaving energised and inspired, but as always I’m keen to hear from you, if you attended or simply were intrigued by what I have shared in these words, and images, so please leave your comments below.

Thank you to the smaccDUB organising team who did a great job, in particular Chris, Roger and Oli, and their team! Also farewell to the other delegates who are part of this friendly ever-growing social media driven med-ed community.

Hope to see you all next year at #DASsmacc!

 

Related posts; 

Scott Weingart: on Vipassana meditation

Andrew Tagg: Don’t forget the bubbles-  smaccDUB summary 

Richard Carden: St Emlyns – A trainee perspective 

Suzie Edge: Primary survey – Speaking out: teams, juniors, leaders and what smaccDUB taught me

 

 

 

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Where science and art meet

Where science and art meet,

Is a very special street,

 

That is more of treat than a destination,

A special universal creation,

 

The speaks the truth of this moment,

As we see it,

 

Do not try and understand,

Simply “Be it”,

 

For whether this place lies under you feet,

Or becomes the seat,

 

That you chose to dwell upon,

You will always find Love,

 

In every direction you look,

If only you can let go of the hook,

 

That keeps you trapped in the mind.

 

Learn to be kind,

And awken the blind,

 

Within you.

 

Those who understand this are few,

But still seek out this special crew,

 

Because this “peace” in life is long overdue.

 

12-6-16

Right now I am feeling quite blessed to be in London, spending the night in a hotel room with my beloved father who I owe so much to. So humble, so caring, the man who taught me what sharing was all about, modelled through the way he lived his life, and the way he provided for his family.

Sometimes when you are the recipient of great genenrosity there can be an immense pressure to reciprocate rather than appreciate. At present I choose to focus on the latter, and perhaps it is my deep connection with the arts that I can see things from a number of perspectives.

During the last 48 hours I have had a brief trip through “London town” which has felt quite special, if not magical, meeting and reconnected with family and wonderful friends. In such a short period of time I feel as if I have journeyed through a diverse range of geography, society, history, and art.

Some of the many highlights include a brief stay with my father in the centre of London, both of us respectively on transit between medical conferences, and having a brief yet meaningful walk along the Southbank of the Thames river. I also managed to pleasurably catch up with a range of friends and relatives including during a short space of time.

This included a dear old friend and flatmate who introduced me to the world of playback theatre many years ago and is now a dance movment therapist; an educational child psychologist who is nearing the end of her doctorate on the use of mindfulness training in schools; a special primary school friend who I have kept in touch with from the days of attending a British international school in Saudi Arabia during the 90’s, and of course the friend who introduced me to a form of mindfullenss training during my PhD fieldwork in Sri Lanka, himself an interesting medical doctor, and researcher in mindfullness medicine.

Finally, my stay in London culiminated with a night out with my dear cousin and her dancer friends in Covent Gardens. My cousin, herself an performing Flamenco dancer, and successful business woman and my old medical muso friend from Sydney, who happened to be visiting London, catching up with his own old friend who likes to experience life to its fullest.

I couldn’t help but reflect that after a weekend of exploration through science (a world that I am embedded within), mindfullness, and travel, it was the perhaps on the dance floor of what seemed like an exclusive London arts club that I again remember the salient importance of music, dance and art, and the quote shared with me by my cousin earlier that night.

“civilizations aren’t remembered by their business people, bankers or lawyers. They are remembered by their arts” – Eli Broad.

This morning as I was leaving on a bus to Victoria station where I would catch a train to the airport, I couldn’t help but notice, one more time, the increadible depth of art that I was surrounded by in London.

Onwards and upwards to #smaccDUB

So as I head towards one foremost conferences in critical care – SMACC Dub (Social Media and Critical Care) I am looking forward to experience more science, and but also more art and creativity. For whilst this conference that is touted at being one of the most dynamic in the arena of critical care, it has also proved to be a meeting place for some of the brightest and creative ideas in health care of modern times.

I am so looking forward to Dublin!!

 

Related posts

Meditation, Surfing and Thesis writing

Emergency Medicine and the loophole of Love

Half way around the world in 77 days

#smaccGold reflections

 

The perils of hidden sugar content: interview with Dr Aseem Malhotra and filmmaker Damon Gameau

I recently watched an intriguing Lateline interview that was with a UK Cardiologist called Dr Aseem Malhotra who is leading a public health driven movement to raise awarness about the perils of sugar that is often hidden from us by the food industry. The following interview shared below is between the BCC reporter, Dr Malhotra and the filmmaker of hit documentary “That sugar Film” Damon Gameau. They present data and illustrations of some key points about the food that we eat, that everyone should be aware of;-

This eye-opening interview highlights the perils of sugar contained in common foods (often marketed as healthy foods).

http://doctoraseem.com/time-bring-back-fat/

It is worth reading the article in full and and also watching the YouTube video of the interview, but in brief the closing key points by the Dr Malhotra the health promoting Cardiologist were;-

  • Eat real foods
  • Avoid processed foods
  • Limit yourself to no more than 6 teaspoons per day
  • Eat full fat yoghurt rather than fat freee
  • Having more fat from foods like olive and nuts – reduces risk of many chronic diseases of heart

Also – the salient message

  • Beware of common foods that have hidden sugar content
  • Eg. 1 tablespoon of BBQ sauce has 2 sugars

This article particlarly strikes a chord with me because it highlights the power of preventative health (and in particular health promotion) and knowledge translation used in synchrony, an intersection that is perhaps going to be one of the best way to tackle many different deeply ingrained habits of modern society that are leading to preventable ill health.

The bridge between “treatment” and “prevention”

During my last 10 years of working as a doctor, I have been repeatedly lead to the interest space that lies between the treatment and preventative spheres of health care. In the process of carrying out fieldwork between 2006 and 2010, and writing up a PhD thesis to do with knowledge translation addressing suicide related death prevention in pesticide self poisoning, I became further aware of the integral roles that both preventative health and knowledge translation of existing evidence have in making an impact in the promotion of health at a global level.

After returning to the Australasian health system 5 years ago, to complete my specialist training in Emergency Medicine, I could clearly see one of the most important gaps between treatment driven medicine and preventative medicine was the lack of a “two-way street” between these two worlds of preventative health (or health promotion) and treatment driven specialist medicine. In some cases the connection between these two worlds seemed more like a like a “bridge” between two very separate islands. It is easy to understand why the gap exists because often in the hustle bustle of a busy Emergency Department, treatment is clearly the focus, and there is very little opportunity to address the problems that have lead people turning up to hospital in the first palce. However, the importance of bridging this gap, and enhancing innovative traffic on this two way street seems to be increasingly important if we are to reduce the overall cost and burden on our emerging health systems.

Public Health innitiatives using media as a vehicle

Health promotion is a complex arena of work that will require engagement of multiple players in the arena of health including funders, governments, health workers, and of course the public themselves (ie the stakeholders for preventative health innitiatives). The health promotion work being done either directly or inadvertently both by award-winning Cardiologist Dr Malhotra and Filmmaker Damon Gameau educating the public on the hidden perils of sugar is quite inspirational, and to me it illustrates useful model of how the intersecting modalities of science and cinamatographic art are being  employed in a goal of improving global health.

Return to Kandahar – Benjamin Gilmour Films

Today I received an email from an friend, author and filmaker is continuing to work his artistic magic by creating films with meaning.

Excerpts from the interview:

Return to Kandahar is about hope, it’s about friendship, it’s about hospitality, and its about forgiveness”

we don’t need pro-war, anti-muslim propaganda films anymore”

what we need are films that promote peace, that promote understanding”

if you believe in justice, peace, in dignity, in fairness and equality, than I think this is a project that you should get behind”

please support it – we need your help”

 

About the Filmaker

Ben Gilmour wrote a book called “Paramedico” which was an exposition of short stories about the tales of an international paramedic who cherished the adventure that his job entailed. I was instantly attracted to read the book whose title seem to fall on my lap, as often is the case with books that I’m meant to read, when enjoying a chai in one of my favourite cafes in the world “Gertrude and Alice – café and bookstore” in Bondi, some years back.

I was lucky enough to meet the man behind the printed words his book launch in that very café/bookstore and we instantly became friends, perhaps connected by a shared passion to improve the world in a small way through combining our backgrounds in health care (in his case being a qualified ambulance officer), research, and of course creativity.

Shortly after meeting ben I saw the trailer for his movie “Paramedico” and was further inspired by his aristic achievement.

Today I read the blur about Ben’s latest movie “Return to Kandahar- one which he is seeking crowd funding support. I instantly watched the 2 minute short film/interview and dontated $15 to the cause and wrote this post.

I hope that 15 minutes of my time can help in one step forward supporting what seems to be an epic film that I would like to watch, as well as a creating a culture of films that the world is so ready for.

Good luck Ben – you’re a legend and inspiration!

Thank you for your work!

2016 reflections and and a some old wisdom for a new year!

Structure is Key

 

Structure is key,

Without out this we cannot be free,

 

From the ups and downs of life,

And the ability to live with a wife, or family,

 

As strife is inherent in all kinds of life,

But it need not cut you like a knife,

 

For when you have an “approach” and a plan,

Whether it be to hang and get a tan,

 

Or follow a career which makes you the man,

That you are seeking to be,

 

You just have to navigate the tides,

And not get lost at sea,
So hold a peace in your mind’s sight,

And let “structure” be the guiding light.

 

31-12-15

 

Structure is the key to everything,

No matter how difficult and messy life seems,

There is always a way to handle the challenges peacefully and productively.

Recently I’ve been working in a new rotation called “General Medicine”, I’ve noticed that the same principles of stucture being the key applies here too. I turn up to work and there often seems to be a mountainous list of tasks to do. To get through seeing all the patients, organise consultations, and organise ward rounds with consultants to formulate solid patient management plans. Then on the tricky days I’m also on call, which means that I have to answer the pager which could be emergency patients that are referred, or ones who would benefit from another subspeciality’s input, and ward consults from other hospital teams.

It is the same when I am working in Emergency Medicine. I’ve learned how “structure” is essential to core business of an emergency physician who has to make some sense and bring order to evolving chaos. Here one strategy is going through the “board” (an electronic overview of all the patients in the department) and making sure there is a plan for each patient as well a strategy for staffing and supervision to handle the inevitible surge’s of patients (trauma’s, resucitations etc) that freqent the department.

 

But how about “life”?

Now when it comes to “life” – how does one structure this project? Perhaps the life arena is the hardest one to manage because it is so dynamic and multiple factors involved. Also there are pressing needs that trump any planning such as “getting food into the body”, “doing shopping”, “having rest”, or “spending time with one’s partner” who is otherwise is constantly waiting around for a life, just washing, cooking and cleaning. Perhaps managing the needs and goals of close loved ones (both family and friends) is the most challenging variable of managing “Life”.

We are not given much guidance on how to manage one’s life, or at least I wasn’t’, but what I’ve come to realise now, is that ironically doing less is the key to achieving more. This is easy to realise, but extremely hard to practice in a world where there seems to so many things that need to be done before we can sit in peace.

After working busy shifts in the hospital it is very easy to feel both depleated and defeated. In recent months, and years, I have found that by giving it “your all” to countless patients and their families, and despite simultaneously trying to be the best support senior, junior and other staff and colleagues, one can still easily leave work feeling that there was more that you could have done. This is not only heart breaking, but it is counter productive, because it leaves one ill equipped to then to come home and pick up the pieces of the most important project of all “life”.

As we head into the new year, at challenging time in my life when facing a fellowship exam is on the cards in addition to the usual mix of dream plans, responsibilities and goals – I take heart in reminding myself that “structure” is the key. I also look forward to the year ahead with a motto that I’ve always kept close to my heart – which is to give out what I would hope to get back, after all they say that “the universe is kind to the kindhearted”, and this has proved to be a personal truth that I am very, very grateful for.

Best of luck for your new year! May all you move one step closer to your most heartfelt wishes, hopes and dreams.

See you on the other side 🙂

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Motivational talk on specialist training and Emergency Medicine

Last month I had the pleasure of talking with the UOW 2015 graduating medical at their “welcome to the real world” workshop lecture series. It was a real honour to be invited to speak about Emergency Medicine with this group of future doctors.

I decided to offer some reflections about my own diverse journey which has spanned several countries and a few different disciplines including surgery (which I embarked on many years ago), research (which led to a PhD that was complted this year) and emergency medicine (which I am currently in the process of completing).

2. My journey

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Some of the highlights of the talk for me was to be able to use a bit of simulation and creative to highlight through direct experience what some of the key elements of Emergency Medicine include. To this end I used a bit of shaking and laughter yoga, an audience surprise, and finally a short guided meditaiton to let the group exeprience the calm within the storm. I was lucky this was such a willing audience.

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The actual talk was a good chance to highlight the importance of knowing onself when chosing a medical speciality, as well as knowing what that speciality is about, and understanding what the job entails; both positives and negatives. For me the key reasons to chose a speciality is related to inspiration, and taking a path towards following an inner dream. Mentorship is key for this long journey, and I am every grateful to have had many great mentors along the way.

1. Why we chose a career path

The talk ended with a guitar peformance of a song I wrote whilst doing field work for my PhD titled Peaceful Revolution. It’s an interesting song about some of the wisdom I learned in the villages of rural Sri Lanka. Part of the song is about how there seems to be much more harmony between nature and human existing in the rural areas, and in the cities where I’ve spent most of my life it is easy to have so much in material wealth, but at the same time so easy to forget to touch the hearts of others.

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The gratitude List

There are always so many people to thank for every talk I give. First and foremost I am grateful to my many wonderful mentors – without whom a talk of this nature would not be possible. Then there was the audience, not only for being a kind and generous audience, but also for participating with some of the off-the-beaten-track interactions that I had schemed into this particular talk. Thanks also to the new graduates;- Dr Hayley Dyke who helped me out with being an improptu back up guitarist for the performance, and of course to the lovely Dr Beatrice Dowsett, a member of the class and workshop organiser who invited me to speak. Bea is such amazing person, talented both within and outside the medical arena. I’ve had the pleasure of meeting her at the local hospital acting/film/drama forum created by Dr Tony Chu with the help of other keen artistic doctors at Wollongong Hospital, who meet up monthly for the what we call Fry Day Drama (read more to find out).

I am also very thankful for the clinical team of which I am part of at at the Wollongong hospital, for supporting me to get across to the university campus to deliver the talk during a busy – (Thanks Dr Venita Visvalingam, my supervising Consultant Physician and Dr Annie McKean our hard working Intern!).

Thanks to Dr Nemeshi Fernando who was one of class who gave me some feedback (which I put on my You Tube channel) about the talk. It’s always wondeful to get nice feedback from the audience, and to know that your message is understood.

But finally – Congratulations to the UOW 2015 class – Well done – You made it!!

and… “welcome to the real world!”

Extra web-links

Please leave your “feedback” below:-

I have included the entire talk above, with some additional slides that include a few medical related poems that I once submitted to an Australasian College of Emergency Medicine (ACEM) conference.

If you are reading this and attended the talk, please leave your feedback in the comments section below. I would love to know what was helpful and what resonated most with you as I endeavour to develop this talk further in the future and your feedback is warmly appreciated. 🙂