Rocky Roads: End of Life Care & Women in Intensive Care Medicine

On Wednesday, 5th October, WIN had the privilege of welcoming Professor Imogen Mitchell to their third dinner at Hellenic Republic in Kew. Professor Mitchell (Deputy Dean of ANU Medical School and Senior Intensivist in Canberra) spoke with great humility and passion about the challenges that we all face in delivering end of life care to our patients. She then moved on to present the ongoing issues of gender equality in Intensive Care.

End of life care is “bread and butter” work for intensive care, not least because many patients unfortunately die in our units but also because of the increasing burden of dying patients in the hospital system itself. An interesting statistic quoted by Professor Mitchell was that 30% of MET calls are initiated because of end of life issues. MET calls are now, in most hospitals, attended by Intensive Care teams and it seems to be falling increasingly on the hands of these teams to recognise that patients are dying and that end of life care should be initiated. This inability to recognise the dying patient and failure to initiate these conversations early in a hospital admission is leading to a failure, on the part of clinicians, to allow patients a dignified death: the kind of death we would advocate for our own family members.

Multiple issues are at play to explain why end of life isn’t being discussed sooner. These include: inadequate resources, limited branding, poor community involvement in advanced care plans, time constraints, and the ability to prolong life in intensive care. Add into these issues the complexities of family relationships, cultural and religious beliefs, it isn’t surprising that this issue is often left to those who feel most comfortable doing it.

Professor Mitchell’s second talk discussed gender balance within Intensive Care and she presented some very interesting data regarding female representation on intensive care boards and within medical schools. In 2015, only 21% of CICM fellows were women and only 13% of ICU directors were women. In comparison with other Colleges around Australia, CICM is behind the eight ball, with only the Royal College of Surgeons having fewer female fellows. Professor Mitchell also drew parallels within academia, highlighting similar data exists amongst female professors and associate professors. The facts speak for themselves: - women are still grossly under-represented within Intensive Care and this does not speak of fairness or equality.

The post-talk discussions were excellent and food for a lot of thought. The discussions could have gone on for another hour at least, with many attendees still having points to make. WIN are pleased to acknowledge the male representation at the dinner and feel that encouraging our male counterparts to attend such events is a good place to start. For healthy discussions to continue about what can be done to increase female representation in this fascinating speciality that we all love, we need our male colleagues to want the change alongside us.

WIN would like to thank all those who made the evening a success, particularly Professor Imogen Mitchell for such an engaging and relevant talks. WIN also gratefully acknowledges the Intensive Care Network and ANZICS for their ongoing support. Finally, WIN would like to thank Amy Choi from Ikaria (now part of Mallinkrodt Pharmaceuticals), who kindly sponsored the night so that we could all enjoy great food and a glass of wine in amongst thought-provoking discussions.


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