The Ripple Effect

Every drop of effort counts,

Don’t underestimate the power of the mind,

Love, then trust, and see what you will find?

For the world is not what it seems on the surface.


Those who have the courage are the ones that beam,

Using energy, inspiration and gratitude as a team,


With positivity, we can only but learn,

Growing like a fern,

Unfolding and understanding,

That in fact “to try our best” is to actually “to be” our best,


Beckoning success as our “fate”,

Accepting this journey in “flow-state”,


For after all,

To be fast is really to be slow,

And to question wisely, is perhaps to know.


26-6-17   Taking the plane home after after an inspiring journey to Melbourne indulging in the world of resuscitation and trauma management at Andy Buck’s ETM course (i.e. th Emergency Trauma Management course). I have come away with a multidisciplinary, multi background “total immersion educational experience” in trauma management. As part of this one of the highlights was meeting some wonderful and inspiring people coming from different stages of training (residents through to experienced and creative consultants educators in EM and Anaesthetics) and coming from different backgrounds of practice (eg. rural GP anaesthetists, Public Health anthropologists, experienced life-style oriented career medical officers) who are perhaps helping us lead health care into better directions.

Thanks for a great course everyone – it really hit the spot! 🙂


#smaccGOLD reflections

A few days ago I attended the 2nd annual SMACC (Social Media and Critical Care conference) conference more fondly referred to as “smaccGOLD” owing to it’s beachside venue location in the Goldcoast, Australia (or was it due to it’s resemblance to the hit album from the 90’s ABBA GOLD??).

Despite having 45 mind maps of notes, over 200 audio and video recordings, and 95 tweets later, I am hard pressed to write a post that encapsulates this monumental professional practice-changing educational event in all it’s glory, but as an alternative, I will attempt to share a few early reflections in the following paragraphs.

Perhaps, if smaccGOLD were a movie, its flyer would read something like this:-

“Innovation, education and creativity at the cutting edge and beyond the confines of convention. This conference was delivered passionate patient focused, idea-nurturing visionaries”

I am being quite truthful in saying that conference was, to date, the most dynamic and inspiring medical education and critical care conference that I’ve attended in my 16 years after finishing medical school (includes the last 7 years where I regularly attended local and international medical conferences during my PhD candidacy that took me across Asia, Australasia and North America).


The conference provided vision for seeing beyond the current challenge facing the health care and education in critical in an increasingly pressured health system. The visionaries who were seen in well established blogging giants like Cliff Reid, Scott Weingart, Chris Nickson, Minh Le Cong, and Rob Rogers, to name a few, and in Educational innovators such as Victoria Brazil and Simon Carly (see the smacc website for the full line up as there were too  many to mention). However, they were also widely present amongst the 1000 plus body of delegates whose ideas were richly intertwined (and archived) through the use of web-based technologies such as “twitter”.

Compassion focused, patient-centred medicine

Perhaps what warmed my heart the most in this conference was the feeling of being immersed amongst open-minded health professionals who care about their patients and who were not afraid to show this through the bare vulnerability of the stage.

There were so many talks, tweets, and casual discussions at the conference relating to a common passion that was relentlessly perusing the improvement of practice to address both challenges in current medical practice, such as improving communication with patients.

A good example of the parallel themes of the conference that communication complex areas of critical care, such as end of life care, and palliative care. One of the most memorable session for me was the morning plenary day 2 which presented case based discussion of end of life care amongst an expert panel which included intensive care physicians, emergency physicians, trainees, palliative care physicians and social workers.

One of the most touching talks was that from Tamara Hills, and nurse who showed us the importance of crisis resource management through her own personal story presented in a video format.

Fun and Games

Finally despite the heavy dose of clinical brain food dished out at this conference, there was some serious fun to be had through the simulation sessions (including Sono Wars, and Sim Wars) the welcome drinks, Gala dinner, and FOAMeoke (karaoke for #FOAM enthusiasts)

Practice Changing?

The ultimate test of any education session is the answer to the question “will my practice have changed as a result of this education?” and for me the answer is a definite “Yes” which I will describe in the posts to follow.

Have a look at a sample of tweets (taken from the hashtag #smaccGOLD – which is a gateway to free open access meducation, otherwise known as FOAMed), and be the judge yourself?

Please post and share your experiences  – after all, the power of knowledge translation perhaps lies in the discussion and subsequent action taken after the knowledge has been consumed…

Adios Amigos 🙂

1. full house 2-1. trauma simulation 2-2. Burr hole 2-3. USS2 3-1. Smacc Gold location 3. roadkill recepies 4-1. Medical student innovation - inolving the stakeholders 4-2. medical education 4-3. conversations on death and dying 4-4. Death and dying 4-5. tamara hills 5-1. indigenous issues  6. 25M impressions

Interesting interview from the “Godfather of Emergency Medicine”

I was just about to go to sleep at 5am after doing my research when I check the Life in the Fast lane’s list of recommended medical blogs. I clicked on a blog called “residing in the ER” and ended up watching a 3 minute video clip which was an interview with Peter Rosen, known for being the chief editor of one of the most highly recommended text books of Emergency Medicine (“Emergency Medicine: Concepts and Clinical Practice). The truncated interview that follows is taken from an in-progress documentary called “Heal Thyself”, and from what I can gather from this clip, explores a physicians struggle through the realities of modern medical practice that perhaps lead to “burn out”. 

The inteview illustrates this physician’s passion for treating patients, with care, and his inspiration of knowing “what to do” in the delivery of acute care. One of the things that moved me perhaps the most was the wise message given as a strategy to avoid burn out – which was  to “revitalise your ideals” and to connect with the “gift of affection”. However, as I watched this video I couldn’t help wondering “have the current systems of medical care changed so much that it is having effects on even the most passionate within the profession?”

I think the answer to this question is “maybe” as the pressures in hospital medicne and particularly emergency medicine are high, and increasing. Why is this? I think it is to do with the mismatch between the expectations of society, the legal system, hospital manangement, and what the doctors themself expect should constiute health care. 

I have had a special interest in burn out for many years now becuase I have always considered myself to be quite an enthusiastic and caring doctor, and, I am very keen that these qualities do not “burn out” – yet although the challenge is worthy, I feel the road is rocky, in todays high pressured hospital environment, and consequently today’s ‘training’ enviroment. Reading what is out there on the blogosphere I started to realise that I was not alone, and now seeing this clip from Peter Rosen it appears that this sentiment perhaps could be in association with esteemed company.

It has been of great interest to me to try and find tools to avoid burn out, and to maintaining the passion whilst walking the difficult path of training and medical practice. In my view the solution lies in “taking care of oneself” – and for me that involves, ensuring rest and satisfying the soul, through the journey of training. But I guess everyone’s path is different? Nevertheless, the concept of “Healing Thyself”, the proposed title of this documentary (from which the above video clip was taken), is of paramount importance if we are to be able to heal others, and this is something I certainly teach or mentor to those more junior than I whenever possible.

Perhaps those of us who are in medical education are familiar with the CanMEDS principles which are thought to strategically address some of these challenging situations created by modern health care – thorugh a more well rounded training of doctors. I think this is a very noble cause, one that I am very enthusiastic about – and the You Tube clip below shows some of these goals nicely played out with acting and music:-

However, whilst I’m optimist by this framework of training, I believe that at the same time there needs to be the development of “collaborative” common-sense expectations of health care delivery, that involve the ‘entire’ society, as a whole, if we are to avoid the mismatch from persisiting.  


Physician Heal Thyself

Physician Heal thyself,

Or you will feel like you are stranded on the shelf,

There is pain you seek to heal, 

But try not to deny what you feel,


How can it not affect me,

When it was ‘feeling’ that taught me to see?

How can it not deject me,

When suffering lives on the other side?


The change of tide is arriving,

Integration is thriving,

For a new age of understanding,

Is collaboratively re-expanding. 


Well there’s my poem for the night – Good night 🙂


Adopting a “beginner’s mind” in delivering medical education!

I just read a great post by a medical student on their blog called “Drinking from the fire hose” talking about some strategies to improve teaching in medical students which prompted the following reply from myself. This post was in itself a response to a post on Kevin’s blog about “Reward or punishment in medical training” (another good read).

Here’s my response – Thanks for raising four great strategies for good teaching  

1. know your audience,

2.  Give real-time specific feedback,

3. Adopt a beginners mindset, and

4. Take time to teach,


I particularly liked the third point;


“3. Adopt a beginner’s mindset when teaching. Lead your learners down your thought process, from beginning to end. Teach your students how to THINK, instead of trying to transfer knowledge to them (the internet is better and bigger than you are).”

The beginners mindset is spoken about a lot in Yoga philosophy and I quite like it. In the game of education, we all started from a point from where we “didn’t know”, and moved to a point where we “kind of know” – and this process was called learning. I think the process of learning and discovery is really fun, but unfortunately under the scrutiny of poor feedback techniques (which essentially is the same as saying “poor communication techniques”) that potentially pleasant experience can become painful (and often does in many peoples experience in medicine). 

Speaking as an educator I couldn’t agree more with the notion that one should “adopt a beginner’s mindset” as this is a great strategy. I also like your comment about “leading learners down your thought processes” as I think this is an essential step which is often missed in clinical education, particularly because of time pressure. However,  I believe the purpose of this is not to “teach your students how to THINK”, but rather to show them how “YOU” THINK and let them decide for themselves of how they can either accept or reject that strategy for themselves in figuring out how “they” will think – either way having presented yourself as the model it can give them a framework for learning how to learn for themselves.  Anyway that’s just my two cents! 

Great pos & good luck with your training!


Bish 🙂


Book Reviews for anyone interested in Medicine, compassion, positivity or Poetry?

I was recently given the opportunity to write recommendations of up to 5 books that I could recommend for a book review section in a popular emergency medicine website that I occasionally write for (Life in the fast lane). 

Recommend up to 5 books, that for whatever reason, you think people interested in emergency medicine and critical care MUST READ. Fiction, non-fiction, graphic novels, poetry, whatever… The world’s your oyster! Submissions will close on March 12 2012. I’ll pull them all together into a blogpost (or series depending on how many there are…)

As usually I left the writing of these recommendations until the last minute (as entries were due in yesterday), however, I did start drafting my responses as soon as I read about this wonderful project. 

Straight away I thought “wow – this is a great opportunity to write about that book that I has really inspired me in recent times” Medicine and Compassion, and a book that shares my favourite prose, “Poetry”, with the medical community. I also thought that perhaps I could recommend a book that will help with a subspecialty I’m passionate about – International Emergency Medicine, after all I slaved away writing a chapter in this book with my supervisor and after recently seeing the book in print I think it could be of benefit to the specialty, and finally I wanted to recommend a book that is all about what I believe is most important in life – positivity and motivation, and “healthy thinking”. As for the 5th book – well I guess there has always got to be room for new opportunities so i’m always on the look out – What would your recommendation be?

1) Medicine and Compassion: A Tibetan Lama’s Guidance for Caregivers
Chokyi Nyima Rinpoche (Author), M.D. David R. Shlim (Contributor)

This is a great book gives practical methods of how to cultivate “compassion” and find our inner beauty so that we can deliver better care to our patients and each other. Compassion is a quality that is easily lost under the stresses and time limitations of modern medicine, but with the logical strategies given in this book perhaps we can all improve this situation? The co-author Dr David R Shlim, is an ex-emergency doctor who gave up the pressures of emergency medicine in the US to work in Nepal in travel medicine. He set up a travel medicine clinic in Kathmandu and there started treating the Tibetan Buddhist monks who ‘taught’ him how to be a more compassionate doctor, something that he previously thought that maybe was something you either were or weren’t born with. One such learned monk was Chokyi Nyima Rinpoche, a Tibetan Lama, who was encouraged by Shlim to share his wisdom and insight with a greater audience through this book. 

The preface goes spells out “The book is timely, as it presents an antidote to the current climate in medicine that is dominated by high technology, and an increased intrusion in medical care by financial considerations.”

The book starts with a line that perhaps many of us can relate to, “medicine and compassion – I don’t think I ever heard those words spoken together in medical school” and goes on to be a simply written, enjoyable and inspiring read!

(I believe this is a “must read” for all doctors!!)

2) Playing God – Poems about medicine,  
Glenn Colquhoun (Author) 2007
Glenn nicely describes some every day events from the world of medicine, and highlights their humanity through the wonderful medium of poetry with this collection of poems. 

As one reader said who gave this book 5 stars;- “It was a long time between poetry reading when I read this book. This made me remember why poetry is so wonderful, good for the soul. This is my favourite NZ poet and anybody who has ever had a loved one fall ill, who has been ill themselves or just who feels compassion will enjoy these poems.”

I remember meeting Glenn back in 2002 when I was about to embark on my first registrar term, which happened to be a rigorous 6 month rotation in Intensive Care medicine at Waikato Hospital, New Zealand, and at that time Glenn was a GP from a remote area had just finished the same 6 months. On that day I remember seeing Glenn at the ward round table and after handing over his overnight patients after completing his last night shift for the term he gave us, a group of scared newbies registrars about to embark on one of the most challenging (but rewarding) ICU terms in the country, some useful encouragement which I remember to this day. 

He told us that no matter how scary the situation there was always guidance in this job, which turned out to be true, and when ever you felt most alone and out of your depth he always heard a voice, almost like the voice of God telling him what to do (only to realise later that this voice was none other than the deep South African accent of John Torrance, or perhaps one of the other Intensivist bosses, telling you to what to do through the department mobile phone!). There was so much humility, humor and wisdom in what he said I really wanted to check out his writings later on when I heard that there was a poetry book published by him, and certainly his writing conveys the same grace that he had in person!

(This is a good book for doctor poets!)

3) Textbook of Emergency Medicine – Vol. 1 & 2 , 
David, Brown, Nelson, Banerjee, Anantharaman, et al., (Authors)
Wolters Kluwer Health (Lippincott, Williams and Wilkins),Delhi, India 2012

This is an Emergency Medicine compendium and the first desk reference reference of it’s kind that was developed and published in Asia. 
Word from the Chief Editor, Dr Suresh David, “Most of our emergency medicine textbooks come from the USA. From an EM academic standpoint the world is divided into the West and the East. We are currently modifying and adapting from the West. So we created a book predominantly for the Eastern hemisphere. This book is a One-Stop-Shop for EM students, EMS personnel, EM postgraduates and ED administrators. He also said that the literature came from authors who were experts in their field. For example, the chapter on Diving Medicine was written by David Greene who is an Ex-Navy SEAL. The chapters on Frostbite and High Altitude Illness were written by Ken Zafren who has experience from Alaska and Himalayas. 

Dr. Judith Tintinalli, in the foreword, mentioned that this textbook matches practices to the resources and cultures of the region, and makes clear that EM is a tangible specialty in India and South-East Asia”

I think this book is would be a useful desk reference for anyone wanting to practice International Emergency Medicine in Asia, and in particular work or teach in the Indian subcontinent!

(By the way I wrote the chapter on treatment of anti cholinesterase poisoning with my supervisor, who is actually world expert on the topic, which is how I know about this book – so I just thought I’d declare that conflict of interest with this recommendation!) 

4) Healthy Thinking: How to Turn Life’s Lemons into Lemonade
Dr Tom Mulholland  
Dr Tom is an irrepressable enthusiast. His career has included being a Doctor, Pilot and Entrepreneur. He has been been a NZ Forest Service Forester, won a First Class Honours degree in Molecular biology and Graduated as a Medical Doctor from the University of Otago. Inspite of his impressive CV Dr Tom learned through personal experience that life sometimes serves us lemons when he lost control of his internet business and his marriage faltered.He writes about how to turn life’s lemons into lemonade as he has. His book has become a bestseller and his and personal speaking engagements for individuals and businesses make him one of the most in-demand motivators in Australasia. He now now also has his own television show Dr Tom – The Attitude Doctor.” – take from an internet book review (link above)

(I have only read sections of this book, but what I read was fantastic! Also my mum is a great fan of his books and her recommendations are worth their weight in gold, which why i included it in the list. I’m definitely going to get my own copy after writing this review and read the book fully mysefl!) 

ANU Research Fest 2010 – Going beyond the Endpoints!

Last week was the Australian National University’s research festival week. The ‘Research fest’, as it is know to ANU’ers, is like an orientation week for research students (MPhil and PhD candidates) where research and teaching life is celebrated. In addition to seminars on “thesis writing” for new students and “strategies for completion” for more advanced students, the University holds a series of social and creative activities including competitions for a research note, presentation of a thesis, acting in skits or presenting a short film clip.
The creative part of university life is something I was loved in my undergraduate years, but unfortunately in the four years that I have been enrolled at ANU for my PhD, I have never been able to attend this Research festival because of the demands of my fieldwork in Sri Lanka. This year was no exception, but this time it was because I am back in New Zealand writing up my thesis, and I am presently on quite a tight schedule to complete this! However, I did enter two competitions ‘on-line’ despite the mounting pressures.

Research Note

For the “Research Note” competition I wrote a Poem synopsis about my research experience that was titled “Going ‘beyond’ the endpoints!”. This is about an aspect of research that I discovered along the way and is something that I feel strongly about (ie. that life is more about the journey than the destination).

Going “beyond” the Endpoints!

Beyond the endpoints are the bits that are not seen,

The thoughts and emotions that lie behind the PhD’s sheen,

And whilst they will not appear in the final binding,

They are the reminders of how the road was so very winding.


Research is more about the journey than its destination,

It is to respect the ‘process’ as well as the final creation,

And the process lies within the changes we experience in “ourself”,

Which sometimes speaks more than that book up on the shelf.


My story is long, but I’ll try and keep it short,

It won’t be like some kind of scientific report!

For this is about a journey of mind and soul,

How this process has helped me feel whole.


I collected data in the depths of Sri Lanka,

Amongst my very own first culture,

Where beautiful rivers flow, and green paddy fields glow,

With coconut trees that surround, where wild elephants can easily be found.


I studied suicidal poisoning and its medical cure,

In villagers who drank pesticides when they felt desperate and insecure.

Some would say it was a cry for help,

Either way, they did not do well.


We tried to understand how to ease the terrible prognosis,

By studying a portable machine that could help in treatment and diagnosis,

But whilst collecting this data, an additional vision was to develop,

Another study – “training doctors in resuscitation”- was soon to envelope.


Whilst in Sri Lanka my mind expanded more than I would have believed,

Working with different cultures and systems into which I’d soon be weaved.

And with this I began to see my thesis as more than a mere ‘cog in a wheel’,

For perhaps, it may bring about change in the world, in a way that is real.


Film Clip

I also put together a 5 minute short film (see below) which is a story along the same theme titled :-
“Beyond the Endpoints – sights, sounds and emotions of the international journey of research”.


I didn’t want to let the movie get in the way of my thesis write-up, because I know that whilst film making and photography are a real passion of mine, they are also a huge consumer of time. However, to overcome this challenge I had a plan of waiting until the day before the film clip deadline before I started to put something together, and in the end I managed to come up with an entry! Nevertheless, it was still an incredibly difficult task for sentimental reasons.
All I could think about when creating this film clip was, “there are just so many people to honour and thank for this incredible journey”, “where do I begin?”.
I also kept thinking to myself “this isn’t ‘my’ project, it belongs to everyone who helped me along the way”, and it really is, including the patients we were trying to help. For without the help of everyone involved in this research I would not have been able to have carried it out, and I wouldn’t have been able to have learnt as much as I did during those years.


I guess really wanted to write this blog entry in honour of these people. Rather than publish a long list of names of people whom I feel indebted to for helping me get even this far, I thought a better approach is to bring back the poem I wrote not too long ago called “An Ode to my friends”  (see below). Please have a read of this Poem, it’s a favourite of mine because it seems to achieve the difficult task of expressing the magnitude of appreciation I have towards so many people who have helped and supported me through these incredible years.

I guess there is really one group of people, apart from my family and friends, who I really want to thank at this stage, even before I’ve finished writing up my thesis, and that is the “SACTRC crew”. The South Asian Clinical Toxicology Research Collaboration ( is the research collaboration between the Australian National University and University of Peradeniya (funded by the Wellcome Trust/NHMRC (GR071669), who provided my academic base and was the “lifeline” and the vision behind my work.
In addition to this I am really grateful for my two supervisors Professors Andrew Dawson and Nick Buckley, because without them none of this would be possible. Beyond this I have to thank “all” those people in Sri Lanka, and of course my family and friends, but the list really is too long, which is why I have left it to my poem to do the work J

Ode to my friends

This is an ode to my friends,

Those beautiful people who are like precious gems.

The ones who help me stay on track,

Who keep me together when I want to crack.


They are always ready to comfort me,

To give me sight when I just can’t see,

And give me might when I feel like a flea,

Yes these are my friends,


And if you think that I’m not talking about you

Well then – think again!

For when it comes to friends, each and every one counts, I truly believe this!

For we are all at different stages of different journeys.


And it is the togetherness and interaction itself,

That creates the movement,

That is necessary and bodes well for improvement,

And the sanctity of ‘what is’.


They say friends will come,

And friends will go,

But this doesn’t matter,

If our acquaintance is more than chatter!


For whether it is now, in the past, or perhaps in the future,

There will be a bend,

And I will see you beyond that my dear friend,

For, after all, there is no beginning and no end.


It is just an ever-growing flow,

Of love, energy. and much much more,

That lies here and also beyond this shore,

This is what we must grow!


And knead it like freshly made dough,

And bake a beautiful loaf of humankind,

One love, one world, and together – one mind!

With this, we leave all our troubles behind..


Thank you for your friendship.

The competition

I haven’t yet heard the results of the competition from last week, but for me it was not about winning, but rather about ‘participating’ in something that struck a chord with me, and provided another dimension to this work that has been a huge part of my life over the recent years.
Interestingly, both these competition entries have helped me in the daunting psychological task of ‘writing up’. One of the hardest things in writing up the thesis is dealing with the situation of feeling like there is ‘too much’ information to put into a logical linear format. I found the situation with the competition entries to be similar in that there appeared to be too much emotion, too many memories, and too much experience to be able to string together a concise videographic or poetic story. It was a daunting task… but I did it!
Similarly with regards to my current thesis write-up, it is daunting but I “AM” doing it, which feels good.
To me these competition entries were an example of the beauty and power that exists when ‘the arts’ are in support of ‘the sciences’, and where one of these two disciplines can help carry out the tasks of the other.
[Ed Note – in the end the Film ended up winning third prize in it’s category]


As always I would love to hear you feedback on the poems or the film clip. Regarding the film clip, I have been very selective and I do not think there is any footage that would breach confidentiality, or cause any embarrassment to anyone – even the elephants and monkeys who have been captured, (but please let me know if there are any concerns, and I will take note and action). Also, I want to make it clear (for the purposes of my own research integrity) that I have not included any of the study data from the actual studies that I conducted.
On the contrary, what I tried to do was present an overview of the four years that I had in Sri Lanka, and I think many of my Sri Lankan friends and colleagues will enjoy seeing this, even though by no means is this a comprehensive account. Hopefully, will be much  more to come after I have finished this write up.
Anyway, I look forward to hearing your feedback.
Finally I have included a few photos of Sri Lanka below. I literally took thousands of photos in Sri Lanka during the past 4 years, and I plan to present these in some way of form after completing my PhD. However, for the moment I just to put together about 60 photos from the first half of the journey (most of these pics are of the early SACTRC days, a lot of them social pics, in honour of these people who made my stay there so nice.) This collection of pictures is by no means comprehensive, as there are so many other pictures that I would like to include, but for the moment perhaps this is something.
This is the motto I am using to get through the write up of my thesis chapters, when I feel like I don’t know where to begin because there is just so much i want to write about – and the answer that works for me is is “Sharing ‘something’ is better than sharing nothing”.