Critical - how to learn from leaders in intensive care

Dr Kieran Walsh

Intensive care is a world apart. In his book Critical, Dr Matt Morgan mentions that many members of the public have no idea what an intensivist is or does. This is true. But it is also true of other doctors who see intensive care as being very different to their usual environment on the ward or in the clinic. When I was a junior doctor, I regularly had patients in the intensive care unit but I treated them quite differently to other patients on the normal wards. Patients were more or less left to the intensivists to decide on tests and treatments. The result was usually a patient who got better but an unexpected side effect was that intensive care medicine remained as much a mystery to me as it did to members of the public. 

So it was great to read Matt Morgan’ book on intensive care medicine. In the book, Matt tells stories of patients and relatives and sometimes of microbes. So what did I learn from the book? 

Firstly, I learned that intensive care is more than just a place. Intensive care can happen on a ward or a high dependency unit or a hospital corridor somewhere between these destinations. It’s more about the patient than the location of care. Good leaders will keep the patient at the centre of their minds at all times. 

Secondly I learned about the history of intensive care and how new treatments for polio slowly evolved into the modern intensive care that we have today. And teamwork is clearly at the heart of intensive care. Severely ill patients with critical illnesses need round-the-clock care sometimes for multiple conditions. It is impossible for one individual or one profession to manage all their problems. They need a team and the team needs a leader who can communicate with them and co-ordinate their care. 

Thirdly and lastly, I learned that I should have spent more time on the intensive care unit when I was a junior doctor and should have spent more time asking questions of the intensivists. It is clear that I could have learned a great deal from them. Is it too late? Reading the book reminded me that the resources that I work on such as BMJ Best Practice cover a range of diseases - all of which affect individual human beings.

BMJ Best Practice is a clinical decision support resource - and sometimes clinical decisions are a matter of life and death. Critical and the stories in it are a great reminder of this. It’s important that we get them right. 

Competing interests 

KW works for BMJ which produces resources that are relevant to intensive care medicine - such as BMJ Best Practice. KW is also a work colleague and friend of Matt Morgan.