What I Love About Intensive Care Medicine
14 Aug 2018
To a junior doctor working in a busy hospital, the Intensive Care Unit (ICU) is a foreign environment with the sickest patients, highly-skilled nurses and specialised equipment. While it can be an imposing place at first, the ICU has so much to offer the junior doctor, even those not planning to become Intensivists.
Beyond the ordinary spectrum of illnesses
Every hospital specialty is responsible for a scope of conditions – Cardiologists see heart failure, General Surgeons see bowel obstruction, Respiratory Physicians see pneumonia. While these teams will comfortably handle most spectrums of disease, when the patient is critically ill they are best off in the ICU. This means Intensivists are the experts of not only the severe end of all diseases, but also the patients that cross the boundaries of the “single organ specialties”. In the ICU, you will see the worst of everything and manage conditions beyond the scope of any other team.
Big picture thinking
Having to consider the complex interplay between all the organ systems lends itself to big picture thinking. This is the extreme end of considering the whole patient, where a holistic view of the situation must be developed. Life-changing decisions must be made for, and with, patients – often without the ability to ask the patient for their preference. Intensivists must develop comprehensive communication and quick thinking skills to manage difficult decisions, and the satisfaction that comes from this process will help you enjoy your career.
Applied physiology
The complex systems of the body and their interplay in times of critical illness are truly the domain of the Intensivist. Nowhere else in medicine will you see such vivid demonstrations of the principles of physiology on a daily basis than in the ICU. You will see the extremes of physiology, captured in front of your eyes through the many monitoring modalities.
Complex decisions underpinned by basic clinical science
While other specialties will have extensive evidence upon which to base clinical decisions, this is often not possible in the ICU due to the uncharted waters we so often navigate. The average ICU patient has multi-system disease with a background of multiple co-morbidities, and it is within this space that the Intensivist must operate. Decisions are often made on the basis of science in the absence of clinical evidence, supported by experience in managing critical illness.
Supporting colleagues
The downside to intensive care practice is often the lack of follow-up when patients leave your care. This means the prospective Intensivist needs to find satisfaction in their work from sources other than patient feedback. Every intern will have felt the relief that comes with a sick ward patient being taken to ICU. You will often find yourself supporting colleagues by looking after their most challenging cases. There is no other specialty that is able to manage such a broad range of conditions.
Endless possibilities
You don’t have to work in a hospital long to have someone tell you, “We can’t do that here”. Whether it is advanced treatment modalities like ECMO and renal replacement, or even (in some hospitals) insulin-dextrose infusions, the general wards are becoming more restricted in what they can manage. You will never encounter this in the ICU where the team can manage any condition, treatment or technology. Sometimes the logistics are better dealt with in a specialty area, but the ICU team are always there to provide support.
No boring bits
Every specialty has its bread-and-butter conditions and intensive care is no different. The difference is that our bread-and-butter is often the worst a “single-organ doctor” will see for the year. Even the most routine ICU case will have its challenges, and this means you will never be bored.
Constant growth as a doctor
In most specialties you will be practising like a boss very early on, and you will reach your peak at fellowship. This means there is a limit to how much you will be able to grow as a doctor. In intensive care, even the most experienced specialist will often be faced with challenges. If you are after a job where you need to be constantly chasing higher standards, intensive care medicine is the path for you.
Dr David Ransley (MDA National Member)
Advanced Trainee, Intensive Care Medicine
Royal Hobart Hospital, Tasmania
Listen to David’s podcast interview with Dr Norman Swan:
Doctors Let's Talk: Get Yourself A Fricking GP
Get yourself a fricking GP stat! is a conversation with Dr Lam, 2019 RACGP National General Practitioner of the Year, rural GP and GP Anesthetics trainee, that explores the importance of finding your own GP as a Junior Doctor.
25 Oct 2022
Systematic efforts to reduce harms due to prescribed opioids – webinar recording
Efforts are underway across the healthcare system to reduce harms caused by pharmaceutical opioids. This 43-min recording of a live webinar, delivered 11 March 2021, is an opportunity for prescribers to check, and potentially improve, their contribution to these endeavours. Hear from an expert panel about recent opioid reforms by the Therapeutic Goods Administration and changes to the Pharmaceutical Benefits Scheme.
14 May 2021
Diplomacy in a hierarchy: tips for approaching a difficult conversation
Have you found yourself wondering how to broach a tough topic of conversation? It can be challenging to effectively navigate a disagreement with a co-worker, especially if they're 'above' you; however, it's vital for positive team dynamics and safe patient care. In this recording of a live webinar you'll have the opportunity to learn from colleagues' experiences around difficult discussions and hear from a diverse panel moderated by Dr Kiely Kim (medico-legal adviser and general practitioner). Recorded live on 2 September 2020.
05 Oct 2020
