12 - Julia Wendon - Making the patient the centre of everything

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 at King's began as a consultant in 1992 and since then she has played a key role in the development of the internationally respected King's liver service, including the expansion of the hospital's intensive care bed capacity. Her primary clinical areas of interest are severe liver injury, multi-organ failure, immune dysfunction and the role of extracorporeal therapies for the management of acute liver failure. She is a respected academic, has published over 150 papers, and is regularly invited to lecture at national and international conferences.

Julia is an articulate, thoughtful, caring and compassionate intensivist, as well as a tremendous stage presenter. Julia was an international speaker at the Australian and New Zealand CICM ASM in Sydney in May 2017 and this gave me a brilliant opportunity to interview her. Having helped to develop a world-leading liver ICU service at King's, Julia gives highly useful reflections on how noone can achieve anything without colleagues and great teamwork; smiling, saying hello and thank you is an important role of being a consultant leader; seeking second opinions is a really valuable regular practice to make sure we aren't missing anything; learning from trainees who have come from other continents and cultures is a huge privilege; looking after patients should always come before attending hospital meetings; and how she revels in allowing less experienced people to step forward and grow so that they can eventually overtake her. Also hear Julia speak about how:

• After enjoying intensive care as a very junior doctor working on a cardiac ambulance team, she trained at Middlesex Hospital in London under role models like David Bihari and Jack Tinker, who taught physiology enthusiastically at the bedside
• She learned so much from the senior intensive care nurses in her younger days
• Intensive care careers sometimes need to be varied in pace, and even head off in different directions at times
• Much can be gained by visiting other colleagues ICUs and even doing a ward round to see how others interact and manage patients
• She often reflects over a cup of tea on how a day in the ICU went and how she could have done things better
• The running of a family conversation can be difficult, is often done better by some than others, is a learnable skill, and requires accurate knowledge of what is happening with the patient, as well as asking the family what their present understanding is, all with the aim that the family can cope with the memories that they will leave with
• Making time for the important things in our lives helps us manage stress; and for Julia this includes clinical work, reading papers, reflecting, doing research, spending time with family, cooking and skiing
• Everyone in a department has different needs, and these should be recognised so that people can be allowed to do what fits with their needs, whether that be research, education, management or even playing golf
• Starting a 7 day week on a Friday can allow for some relief on the sixth or seventh consecutive day if this is required; which is less possible if the week starts on a Monday
• She would love to go back and study pure mathematics
• She worries we think about stress and burn out but that we don't do enough planning for what we will do when we are finished medicine
• We could use our journal clubs to allow us to present our favourite life habit to our colleagues
• Handover has become a greater responsibility as ICU teams have got bigger

With this podcast, and the previous episodes, please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you helped spread the word by simply emailing your colleagues or posting on social media.

If you want to send a comment or respond to something Julia said on this episode, feel free to email me andrew@masteringintensivecare.com, leave a comment on the Mastering Intensive Care podcast page on LITFL or on Facebook, or post on twitter using the hashtag #masteringintensivecare.

Thanks so much for listening. Please give your patients the very best care you can, and take care of yourself too.