Articles and Case Studies

What I Love About Intensive Care Medicine

14 Aug 2018

by Dr David Ransley

icu

The strange world of intensive care medicine is completely unknown to most patients, and even most doctors. So what does this specialty have to offer the prospective Intensivist?

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

david ransley

Listen to David’s podcast interview with Dr Norman Swan:

What I Wish I'd known about Intensive Care Medicine

Intensive Care Medicine
 

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