RickInOz

After the days off and frivolities in the sea I’m back at work again this week. I thought I’d share an aspect of critical care medicine that plays an unseen, yet important, influence.

As I’ve mentioned in a previous posting, the intensive care unit as a whole is measured and assessed by successful outcomes and comparison versus an accepted standard. How then do you measure performance of individuals? The most common method is examinations, but this only captures a snapshot. Doctors abilities and knowledge can fluctuate and may not always meet the demands of the job. Fortunately working in a team-based environment tends to encourage good standards and a degree of automatic quality control.

Another variable, and this is the point of my post, is practical skill. When doctors are recruited, their CVs are reviewed, an interview may be conducted and referees canvassed. However the future employer, and their staff, still have no idea whether that applicant will be able to do the required tasks. Therefore for relatively new staff like me there is a certain amount of pressure to perform as expected. This is most tangible when doing practical procedures.

Today I was asked to insert a pulmonary artery catheter in one of our patients. Unexpectedly I had an audience, of junior medical colleagues who wanted to see how it was done, and senior nurses learning how the new ICU monitors worked. My hands were shaking a little being under the hammer like that, but fortunately it went smoothly and my reputation was secure.

It is not always that way. From time to time I, like many of us, make mistakes and am unable to complete procedures as intended. In such a situation I tend to give myself a mental kicking, despite full insight that nobody is perfect and it usually doesn’t matter that much. While procrastination isn’t healthy, it does serve as a valuable internal quality check. So hopefully standards are maintained and there is no need for more frequent exams!