‘So you want to be… an intensivist’
August 26, 2010 2 Comments
Blog Post by Dr Darcy M Pearson FRCA, Specialty Trainee in Anaesthesia & Intensive Care, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK, Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK, and Dr Kamen Valchanov MD FRCA, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK
DMP: How long have you worked as an Intensive Care Consultant?
STW: 2 years
DMP: When did you decide that you wanted to pursue a career in Intensive Care Medicine?
STW: During my training in anaesthesia I realised I enjoyed managing sick patients in intensive care as well as anaesthetising high-risk patients in theatre. Both interests led my down the road of a career in ICM and cardiothoracic anaesthesia.
DMP: Did you have an opportunity to experience Intensive Care Medicine as a medical student?
STW: Yes, during my anaesthesia attachment I had the chance to go to intensive care. I remember being impressed by the broad range of skills and knowledge required in intensive care and by how calm and approachable intensivists appeared to be! The combination of physiology and pharmacology in action attracted me to the speciality.
DMP: Can you describe the training pathway to Intensive Care Medicine
STW: I trained in anaesthesia and ICM in Northern Ireland and obtained a dual Certificate of Completion of Training in both specialities. Training was organised by the Royal College of Anaesthetists (RCA) and Inter-collegiate Board for Training in ICM (IBTICM). Training is now changing with the set-up of the new UK Faculty of ICM (FICM) so watch this space……
DMP: Many perceive the role of an ICM Consultant as highly stressful. Do you find this to be true and what strategies do you employ to enable you to cope?
STW: ICM is a challenging and absorbing speciality. Good team-working, time management and communication are needed to ensure things get done and to prevent stress.
DMP: Can you outline a typical day for a Consultant in ICM?
STW: Each unit works differently but a typical day would include handover from the night team, daily systematic review of patients in the unit, multidisciplinary rounding (including medical, nursing, pharmacy, dietician, physiotherapy staff), discussion with referring consultants about ongoing management, assessment of potential new admissions in conjunction with the outreach team and arranging interhospital transfer of patients to/from the unit.
DMP: Is the working pattern arduous? Is it common for you to be needed outside of normal working hours and do you ever wish that you had chosen a more sociable career?
STW: Yes, the work can be arduous. The ‘normal’ working day is long and on-call duties can be busy either giving telephone advice or assessing new admissions.
DMP: Arguably ethical dilemmas such as when to withdraw treatment pose the most difficult challenges in ICM. Do you agree with this and do you find it difficult to make these important decisions? Do you often seek the opinion of other colleagues in making difficult decisions?
STW: Allowing patients to die with adequate control of unpleasant symptoms is one of the most important aspects of ICM. A caring approach, openness and honesty remain the foundations of all end-of-life discussions with patients, relatives and colleagues.
For more information, please see Core Topics in Cardiac Anaesthesia, 2nd edition, edited by Joseph Arrowsmith and Jonathan Mackay, and Core Topics in Thoracic Anesthesia, edited by Cait P. Searl, and Sameena T. Ahmed, published by Cambridge University Press.