Podcast 019: Intensive Care Medicine With Dr Stuart Lane

Where do you go if you have multi-organ failure and teeter on the cusp of death? An important three-letter acronym: ICU!

In this episode, Dr Stuart talks about the hectic life of intensive care medicine, being a good doctor and the importance of morals.

Podcast

About the guest speaker

Dr Stuart Lane graduated Medical School at the University of Newcastle-upon-Tyne, UK. He commenced his appointment with Sydney Medical School in 2007, where he is now an Associate Professor, along with his clinical role as a Senior Staff Specialist in Intensive Care Medicine at Nepean Hospital.

Dr Stuart has a strong passion and decorated record for teaching, and has developed a national and international reputation in researching human experience using qualitative methodologies. He is a part 1 and part 2 examiner for the College of Intensive Care Medicine (CICM), NSW CICM Supervisor of training, and deputy chair of the NSW CICM regional committee. He is a keen swimmer and in 2017, he swam the English Channel in 2017, raising $12,500 to assist research into chronic critical illness.

Music credits

Opening and closing themes by Lily Chen.

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Why You Have To Try For Anything Worth Fighting For

What is the thing that’s most worth struggling for?

For some people, like those in the cartoon world of Disney’s Mulan, it’s a girl.

For some people, it’s travel around the world and the spectacle of standing on a beach at sunrise with friends who make you smile.

For some people, it’s the chance to become better at an important hobby, skill or craft.

For some people, it’s the opportunity to be a good doctor who doesn’t kill patients through malpractice.

Life involves effort. Why must this be so? Why is there no option to stop the exertion yet still be wildly successful?

This can’t happen because it’s a contradiction. You can’t be satisfyingly successful without the tough input that goes into making it happen.

Simply put, no struggle means no achievement. And if something doesn’t take work, it’s not all that satisfying in the end because anyone could have done it.

In fact, the toughest things in life are often the most rewarding because of two reasons. Firstly, the glow of having conquered insurmountable odds is something to be relished in. It feels great to know you’ve done something difficult, because it shows you had what it took to defeat the enemy.

Secondly, that which is correlated with a high cost is frequently that way because the benefit is accordingly high. There could have been countless game characters who walked off and did something utterly mundane. Think of Harvest Moon. Farming might be glamorous to some, but it sure seems like a drag to most. Yet, only Link, Mario and a handful of crazy protagonists like that have made it into the leagues of fame. This is because while everyone else knocked off the easy challenges, all that was left for them were the toughest ones that involved princesses and castles. When everyone else is off doing easy things, the easy becomes common. What’s left to rise above the rest is, by comparison, hard and that’s what makes it all the more spectacular.

It takes work to do things and do them well. This is because there are so many ways life events can go wrong but far fewer ways in which they can go right. That’s why it takes organisation, effort and struggle to sort items in their correct places and to put toys back into the right box.

There are many ways in which you could provide bad management to a patient. You could take a poor history, you could examine them less than thoroughly, you could order the wrong investigations, you could treat them with disrespect, you could act immorally. Yet there’s only one general way in which you would be functioning as a good health care practitioner: by making sure all of these areas were adequately fulfilled.

That’s why there are more possible outcomes in which things fail than in which they succeed. To succeed, a variety of domains have to be met. A whole bunch of conditions have to be fulfilled. Yet, to fail, all it takes is one area falling below the pass mark.

Life and everything important in life is a series of circuits, a complex machine. It’s one where any weak point can cause the entire device to fail, whereas success demands that every part is operating appropriately. This is only one way to do this: work.

If you want to succeed, if you want to live the best life possible, if you want to discover experiences that are rewarding, if you want to win the girl and save the day, you have to invest effort. You have to put in the work.

The beauty of this is that work never fails. Solutions are always possible. If you haven’t found one, you haven’t finished the search yet. As long as you keep trying, you never fail; it’s simply that you haven’t fully succeeded yet. As long as you keep trying, there’s a possibility things will go right. As long as you keep trying, you can achieve your goal.

The only moment you do fail is the moment you stop trying and your fate becomes set. From that time onwards, the world isn’t going to turn in your favour; everything tends towards going wrong, because it’s far easier for things to do that than to go right. Again, there are more ways to fail than to succeed.

Happiness is what people aim for, whether that’s through a contribution to the world or simple self-gratification through riches or reputation, and that takes work. No one owes you that; you have to earn it yourself. You have to take the time, effort and sense of never giving up. You have to take all of that and invest it into sorting things out. That’s how you make things go right; they won’t merely arrange themselves in your favour without you trying.

If you don’t do that, someone else around you will. Then, even by comparison, you’re more prone to fail because others are racing ahead. It’s not enough to say those around you are incompetent colleagues so it excuses you being the same. It means you all lose. If they work hard and you don’t, you still lose and you lose even more compared to your peers.

The only solution is to try. Forever. Always. Doing your best to be the best possible person you can.

Life is only ever going to go more wrong, so it’s up to you to take actions to make it right.

You only live once in this world as it is now, regardless of your mystical beliefs, so you might as well do it right.

After all, you might be reincarnated as a snail next time and then you won’t even have legs. It’ll be impossible for you to be a good doctor if you’re a snail with no legs.

References

  1. Clear, J. (2018). Entropy: Why Life Always Seems to Get More Complicated. [online] James Clear. Available at: https://jamesclear.com/entropy [Accessed 2 Apr. 2018].

Natalie Rapportman

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There are reasons to have good patient rapport.

When you play charades and your team mate is writhing around on the floor making squawking noises* and you spontaneously yell out “shark!” before being met with the sounds of ecstatic relief…that’s based on rapport. You knew the answer because you had a connection with your friend who regrettably never attended acting school.

*When everyone’s miming is so bad that nothing makes sense, cheating is allowed and even encouraged.

People deserve respect, so treating them well is obviously a given. However, it can also help management; a patient who feels listened to is often one who listens to you in return.

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If yo’ having compliance issues, I feel bad for you, son. I got 99 problems but rapport ain’t one.

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That said, let’s assume for a second that treating patients like people has no value beyond being nice.

In all truth, you’d rather have the worst, most offensive doctor who’s the best in the world…

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…than the extremely likeable but utterly incompetent clinician.

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However, we don’t have that information in real life. There isn’t usually firm guidance about who the best clinician is, so what can we do? You know, aside from going to medical school with a large cohort and ferreting out the good and bad ones from that experience.

Interestingly, outward behaviour can serve as a proxy.

The doctor who takes the time and effort to be nice to patients? Well, they just might be the one who takes the time and effort to interpret the history more thoroughly.

Perhaps they’re the one to take the time and effort to perform a fuller examination.

Or maybe they’re the one to take the time and effort to order the right investigations.

Clinical competence is obviously a requirement, but there’s more you can do on top of that. How can patients who never attended medical school with you know if you’re prone to passing spectacularly or flunking dramatically? You can show them that through the way you treat them with respect, attention and concern.

You might still be a horrible doctor, although let’s certainly hope not, but treating patients with respect is such a small switch that you can control with ease. If we treat competence and attitude as two separate things, it’s better to be a bad doctor with good bedside manner than just a really bad doctor.

At the very least, it’s nice to be nice to people.

To Keep Your New Year’s Resolutions, Be Less Rational

It’s the start of a new year, which means the start of another 365 days of procrastination.

The remedy for procrastination? An impending deadline, probably. Or behavioural economics, which is all about recognising and addressing inherent human biases; this lets you optimise the way you carry about your daily business.

But sometimes you need to use these biases to your advantage if you want to stop compulsively looking up pictures of cats in saucepans instead of studying…or if you’re prone to sitting on your fat ass all day.

It’s okay to use the word “ass”, right? Is this supposed to be family friendly?

3 things there:

  1. Cats in saucepans are adorable.
  2. A lot of people don’t like studying/dieting/exercising/[other productive activity]. They know they should do it but can’t bring themselves to.
  3. Instead of trying to diminish your biases, you can harness them to work in your favour.

So let’s address and embrace these biases.

1. Sunk Costs

In an unprecedented moment of heated passion, or maybe when I referred to your fat ass above, you bought yourself a gym membership.

A gym membership is a sunk cost, meaning it’s already been paid for. While there’s not much you can do to recover it, you also don’t have to pay another cent; this fee is totally in the past.

Future decisions should take this into account by dismissing the sunk cost completely. So if you’re rational and you hate exercising, it makes sense for you to ignore the membership altogether.

You won’t receive your money back, so why put yourself through hours of pain for a lost investment? It’s better to let it go. So much for your New Year’s Resolution!

But if you allow yourself to be irrational, you can conjure up the fear of this money going to waste even though it’s technically not — and use it to inspire positive action.

Whether it’s a gym membership, subscription-based study tool or expensive dieting program, the principle is the same. Pay for big commitments up-front and then stand by them to avoid feeling like you wasted your money.

Conclusion: Honour sunk costs.

2. Endowment

The endowment effect is a bias where you overvalue things you own. In essence, you’re scared of losses and hold on too tightly to what you already have.

Maybe you hate fur coats, especially ugly ones. But then your atherosclerotic life partner gives you the ugliest fur coat you could ever imagine. Oh, and you suddenly become Miley Cyrus.

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Now you have a sentimental attachment to this fur coat, because it’s your ugly fur coat. It’s no one else’s. It’s yours.

Then disaster strikes. Someone breaks into your house and steals your ugly fur coat. Just that fur coat. Nothing else.

Now you feel the sting of losing the ugly fur coat, even though you’d been just as happy before you ever received it.

Why? Because you’re scared of experiencing losses and you place a high value on what you perceive you already own. Something that was yours was taken away and you don’t find that a fun experience.

Now here’s the effect it has on your New Year’s Resolutions. When your desire to change is expressed as a loss, it’s hard to follow through with it. Stop eating junk food? Stop reading useless things on the Internet? Wear less ugly fur coats? No, no, it’s all too hard to do.

Instead, rethink what your goal is. Maybe it’s to achieve better health. Maybe it’s to focus more on your study or work. Maybe it’s to improve your fashion sense. These are gains, not losses, and therefore feel more palatable.

Conclusion: Rephrase resolutions as things you will do instead of things you will stop doing.

3. Framing

Phrasing matters, doesn’t it? Actually, it matters a lot. How you express things deeply affects how you think about them.

The classic example is a village with 600 people. You have access to a medical program that saves 200 people. That sounds good, doesn’t it?

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But you can look at it another way and say the program lets 400 people die. Although it’s the same thing, it suddenly sounds much worse.

Expression makes a difference, even if the things being expressed are exactly the same. In experiments, simply changing the wording affects people’s decisions.

So you know what? Use this to your advantage. To ensure your goals feel like successes, reframe the way you think about them.

Make your New Year’s Resolutions ridiculously easy. Make them achievable. Then reward yourself focus on the positive and celebrate what you do achieve, not what you haven’t yet.

Because in the true spirit of procrastination, you can always do that later.

Conclusion: No matter how small the win, focus on what you do achieve rather than what you do not.

References

  1. Lenton, P. (2016, December 30). Make your New Year’s resolutions kinder, and they’ll be more likely to stick. The Sydney Morning Herald. Retrieved from http://www.smh.com.au/
  2. Thaler, R. (1980). Toward a positive theory of consumer choice. Journal of Economic Behavior and Organization, 1(1), 39-60. doi:10.1016/0167-2681(80)90051-7
  3. Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211(4481), 453-458. doi:10.1126/science.7455683