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Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their knowledge and expertise in radiotherapy and oncology by utilising the award winning, first therapeutic radiographer led oncology podcast and social media channels.
We're empowering healthcare professionals worldwide by providing free, CPD-accredited radiotherapy and oncology education, by sharing real-world experience, expert insights, best practice and patient perspectives, we're helping healthcare professionals’ advance cancer care and improve patient outcomes.
Jo McNamara Rad Chat Host (00:00)
Hello everyone and welcome to Rad Chat, founded by me, Jo McNamara.
Naman Julka-Anderson (00:04)
And me, Naman Julka-Anderson. Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their expertise in therapeutic radiography and oncology. Unlike traditional academic resources, we blend real-world experience, expert insights, best practice, and patient perspectives.
Jo McNamara Rad Chat Host (00:21)
We make advanced knowledge engaging and accessible, supporting continuous learning and professional development without compromising patient care or your personal time by providing insights into both technical skills and career development, helping you to progress confidently in your field and shape your professional future.
Naman Julka-Anderson (00:38)
Just to let you know, our episodes may contain sensitive and difficult topics that you might find distressing or triggering. Please consider checking out another episode.
Jo McNamara (00:47)
So this is episode 208, which is part of the education and workforce development series, where we're going to be hearing from our guest, Professor Matt Morgan, about his role as a consultant in intensive care and his experience of witnessing near-death experiences. So Matt, welcome to Rad Chat.
Matt (01:03)
Thank you very much. you for the warm welcome.
Jo McNamara (01:05)
We're really excited to have you on the podcast and you came heavily recommended by our friend Lisa Whitaker who heard you speak and said he's amazing you have to get him on the podcast so a big shout out to Lisa for convincing you. So Matt for anyone listening tell us a little bit about yourself and how you got to where you are today.
Matt (01:28)
Yeah, I guess there's three kind of bits to my work life, I suppose. As you said, I'm a full time intensive care consultant in the NHS in Cardiff, which is a big, busy intensive care unit, mixed, fascinating medicine and good colleagues. And the other two bits of my life are involved in education research. So I work for the British Medical Journal and I'm a columnist for them as well. But it's the third bit, I suppose, of my life, which I've...
enjoyed the most over the last couple of years or so which is I've gone into the area of public engagement and I kind of stumbled into that if I'm honest through writing a book back in 2019 called Critical which is all about the science and stories of life at the edge of life and death really and I was never a writer before I genuinely couldn't spell my name in school Mrs Jenkins my
primary school teacher shouted at me for spelling my name incorrectly. But I've now discovered kind of the power of words, I suppose, and the power of things like this that you're doing in terms of podcasting. And I can touch more lives and affect more lives than I ever could with my hands in the intensive care unit by speaking to people like you, by writing books and by doing other public engagement events.
Naman Julka-Anderson (02:45)
Why intensive care?
Matt (02:48)
Wow,
yeah, why Intensive Care? Well, I actually told my careers tutor something very different. I told her that I'd like to be Fox Mulder from the X-Files. I don't know if you're X-Files fans, but that wasn't possible. I grew up in a small industrial village in South Wales called Neath. Not much need of international spies there, unfortunately, but...
I think the truth is it feels a bit like that now when I go to work. I use science and data in order to try to solve mysteries, if you like, and it's grounded in what's important, which is humans. And I guess in retrospect in school, those are the things I loved actually. I loved science. I loved trying to solve puzzles and tricky questions, but I also quite like humans.
And a day in intensive care is really filled with those three things.
Jo McNamara (03:42)
Matt, quite a lot of your work that you've kind of talked about and related to around public engagement is along the lines of communication medicine. Why do you think it's so important that we have that public engagement element to being a healthcare professional? Because actually, from Naman and I's perspective, you know, sometimes we see
engagement in that way as something that's quite scary, something that can get you into trouble or that other people maybe eye roll out or think you know who do they think they are by representing the profession and talking on behalf of other people. You know what what's kind of been your experience of moving into that and why do think it is so important?
Matt (04:22)
Yeah, you're right. It can be uncomfortable and probably some of the most stressful times I've had in my career are not to do with practical procedures or tracheostomies that have gone wrong. It's to do with things I've said or the way things are being interpreted in public. So you're right. I think at the same time, we forget that, yes, we've got amazing tools and science and drugs and machines and intensive care, but actually probably the most important thing we do
and the most dangerous thing we do is communication. You it's no coincidence that most referrals for professional negligence to bodies like the General Medical Council or others relate to communication. And it's also no, it's also no coincidence that medicine and healthcare people working in medicine, it's the most scientific of the humanities, the most humane of the sciences
you can't do one without the other. And so for me, it's a perfect mix of that. Yes, I can affect the lives of a small number of people when I go and work a night shift by working out the diagnosis or having a treatment plan, but actually through public engagement, you can affect the lives of far more people. For example, my latest book is called A Second Act, which talks about
what happens when somebody survives an out of hospital cardiac arrest, or in other words, when they get a second chance at life. And in out of hospital cardiac arrest, the most important factor of whether you're going to survive or not is nothing that I do or the staffing intensive care do. It's whether somebody does bystander CPR, you know, a member of the public, a member of your family, a non-trained professional.
So I think public engagement comes completely hand in hand in the job that we all do in medicine.
Naman Julka-Anderson (06:20)
Obviously communication is very difficult if you're not face to face. How do you manage those conversations with relatives and family who can't be there?
Matt (06:27)
Yeah, you're right. Conversations are hard even when families are there. You know, the time I meet somebody at 3am is the first time I've ever met somebody and it's to give them the worst news of their life. It's to say that, I'm sorry, your mum is sick enough to die or your son has died, for example. So they are incredibly difficult things to talk about even when you're there. And yes, because of the nature of
tertiary care where things are centralized. Sometimes families can't be there on time or can't travel at all as they couldn't in COVID for example. You know there's no easy answers. think what you need is to be honest, to be clear, say the things that are uncomfortable to say but also remember that you you're speaking to another human and life and death are just...
10 and 2 on a clock, you know, they are super close together and we will be in those positions at one time. You know, I think the world that you guys work in, the world of cancer, for example, it's gone through a revolution in the last decade or so where the C word used to be a word you couldn't say. I remember my family, lots of people in my family have sadly died from cancer and it was in
whispered conversations and corridors. And we've got to a point now where, you know, I can't run around the local park without seeing people with t-shirts with the word cancer written all over it. And that's great. But actually, I think we've moved on. It's now a different word, which is hard to say, a word which I need to talk about quite a lot, which is the D word, which is death. And so if there's one tip for people listening in terms of breaking bad news,
it would be not to beat around the bush, to be humane, but also to say that D word, so the word die. I often use the phrase, which isn't mine, it's from an amazing palliative care physician and author, Katherine Mannix, and the phrase is, I'm sorry, but they're sick enough to die. And for me, that includes three really important things. It includes the D word, the die word, which you've got to say.
It also includes hope because it says sick enough to die doesn't say they are going to die. So there's still hope there. And it also recognises critical illness, which I think those are three really important things.
Jo McNamara (08:47)
Yeah, we've had the pleasure of having Katherine on and absolutely amazing the phrases that she utilises and it sounds like it's perfect for healthcare professionals to really learn how to kind of have those deep and honest conversations and ensure that people and family know what's actually going on. In terms of patients themselves, know, Naman and I get to work and have the privilege of working with a lot of patients who are, you know, dealing with
their kind of own mortality really and they have been told that they are coming to the end of their lives and you know that they will die as a consequence of their cancer. You know how can they prepare themselves from all your experience of being an intensive care doctor and talking about death and dying is there something that people can do or is it actually it's around the support that the healthcare professionals are giving?
Matt (09:36)
I don't think there's one way and everybody is different. You some people want to be super organised and take all of the stress around the family who are left behind. Others want to, you know, do those amazing things they've always wanted to do for a long time. So, you know, I don't think there's one neat package, but in order to get there at all, it must start from a place of honesty, as you say, in terms of having those conversations and not walking away from those conversations.
And also, I think, you know, just as important as that is, is kind of the afterlife. You know, people often ask me, do I think there's an afterlife? And the answer is absolutely yes, but it's not the one you think. There is an afterlife for the family and the people who are left behind. And, you know, I often think that, in fact, we don't die once, we die twice. We die when our body dies and we die when...
somebody stops saying your name. So in those times afterwards, you know, whether it's families in intensive care or friends and families that I have, I'll make a purposeful effort actually if somebody says, you my dad died or my mum died. The first question I often ask is what was their name? And I think something as simple as that can change that narrative, can change that
conversation a lot. And sometimes I think you just have to sit in the rubble really with families going through that in order to properly listen.
Naman Julka-Anderson (11:06)
How do you know when it's time to stop doing something in your setting?
Matt (11:10)
I think it's very difficult and the truth is people like to think medicine is full of black and white areas and it's completely not. You know there are just so many shades of grey and the same is true for science really. isn't about certainty. Science is about admitting uncertainty and I think there's probably three words we don't say enough in medicine. know if the three most important words in life
are probably I love you. The three most important words in medicine are I don't know. And so I think introducing uncertainty around these times is important. Often I'll say to families that we have lots of amazing machines in intensive care, but they don't fix problems. They just give us time to work out what's wrong and then try to fix them. And maybe we've got to a point where those machines are no longer doing
that they're no longer helping us fix a problem, in which case we're going to stop using those machines. And when we do that, I think the person you love will die. And I often use the word think because, you know, sometimes you can be wrong, sometimes amazing, unusual, rare things can happen. And I think admitting uncertainty in the roles that we all play in healthcare is really hard. But I think it's increasingly
important too.
Naman Julka-Anderson (12:28)
It's also harder for other people when, I suppose, if clinicians or healthcare professionals aren't fully honest. I think that's something, obviously, with Katherine Mannix coming on, and she's done quite a few good videos that are on YouTube, which I've used in teaching, just to say, actually, when you say someone's passed away or someone's gone, know, sometimes families might think, where have they gone? Not that they've actually died.
Matt (12:46)
Yeah, completely.
I've certainly said people have, you someone's gone, your mum's gone to a better place and they say, where's that? Is it Newport? For example, and you know, now in retrospect, it's almost comical. But when you're in those stages of grief, you cling on to any form of hope. I guess if I was to talk to listeners of one technique that I do use talking about when is the right time to move away.
I have started over the last couple of years using something I call the empty chair technique, which is borrowed from psychology. And often at the end of a difficult conversation or a bad news conversation, I'll talk to the person who's there and I'll say, look, if your dad or your mum was sitting with us here now, and I'll point towards an empty chair in the relative's room, for example, and listening to what we've said about them, how ill they are
what do think they would say? What do they love in life? What would they say to us if they could? And I think for me, what that does is it almost gives families the position and the privilege and the permission, if you like, to speak on behalf of that person. Because I'm a dad, and if my daughters were ever critically ill, I would find it impossible to say words like, just let them die, let them go.
But if you're projecting through that person, knowing what's important to them in their life, what they love, actually gives people permission to do that sometimes. And families will often crack a joke, they'll say something which they would never say themselves out of their own mouth, but they're all more speaking through the mouth of the relative who can't be there in an empty chair. And I found that very, very helpful and very powerful.
Jo McNamara (14:27)
Really good tips there, Matt.
In terms of kind of your research and other areas of interest, you've talked quite a lot about the role of AI in healthcare. Tell us a little bit, what's your thoughts and feelings? Because it's very mixed, isn't it, within healthcare and also the general public's perception of how we are using AI within healthcare.
Matt (14:55)
Yeah, my PhD was on sepsis and how we can identify the causative bugs that are causing severe infection in critically ill patients who have sepsis. And at the time that was doing lots of fancy tests on the immune system, maybe 300 variables. And at the time it would then be using quite basic statistical tests to try to work out, you know, which are the most powerful markers. And it occurred to me, this was quite some number of years ago now, that
you know, it's crazy just using one or two markers to try and predict something as complex as that. And so I look to other industries, I look to the financial industry actually, and how they were predicting things like interest rates and stock market changes. And it'll be no surprise that they use all of the data they can get their hands on. You know, they don't just use one marker here or there
and they needed to put this data into complex models and complex algorithms. And one of the ones that I found was a relatively new model at the time, which was called neural networking, which is now the basis of much of the revolution in large language models in AI. And so that's how I stumbled into the world of AI, if you like. I think it's transformative.
And like all transformative things, there are risks and benefits. Although what I would say is, you know, the word AI sounds super scary, but of course we've been using versions of this for decades. As long as I can remember an ECG comes with a little interpretation in the top, which suggests, is this AF for example, or is this a heart attack? Well, you know, that's a primitive form of complex algorithms and AI. ⁓
It's not a large language model, of course, but another similar type. And equally, although there's massive possibilities there, I think we forget in the world that we're working. I've still got a pager on me from the 1980s. So I think that, yes, there can be revolutions through AI, but there can be just as much revolutionary change in health care through a moral revolution
or a revolution in the way we communicate or the way we write, for example. And hopefully, AI will be a means of those other revolutions being more effective and safer.
Naman Julka-Anderson (17:11)
I feel like I've got to ask then. So, Chat GPT is going to have an open AI medical model, isn't it? Where you can put your treatment plans in and things like that. we already see it. Patients are putting their treatment plans or diagnosis into very open AI models to find out what the best course of treatment is, why they're not getting certain aspects of some drugs or whatever it is. That's kind of heading in that direction, isn't it, at the moment?
Matt (17:34)
Yeah, and actually I'm quite a technophile. generally err on the side of having that knowledge out there and in a democratic way and in a way that others can access is probably overall going to be a good. You know, we need to remember medicine is basically an act of navigating, navigating doubt gracefully and having information can help navigate that doubt.
But my hope is what that will do is give more time for that nuance, more time for that really human aspect. We've talked about communication. You know, I don't think we're ever going to get to a point where somebody wants bad news to be broken through an LLM or somebody to be told that their mum has died through a chatbot interface. You know, that that's what we are for. That's what humans are for. And just like there is perhaps more worth
in a human drawn sketch or a human made piece of music. Not because it's necessarily better, but because it has meaning. And I think this is a constant search for meaning, medicine more than anything. So my hope is that these facilities, these developments will give us more time for what really matters, which is navigating doubt, talking to people, supporting people, the humane aspects of medicine.
And if a diagnosis can be made faster, more accurately, then great. I think that's an amazing thing, not necessarily a bad thing.
Jo McNamara (19:07)
Matt, we couldn't have you come on Rad Chat and not ask you about your medical advisor role with some Channel 4 shows and also programmes like Casualty. How did you get into that? I'm really intrigued as to how you got kind of into that and is it you we have to blame when the radiographers pull up an old film and it's back to front?
Matt (19:28)
Well, the biggest role I've played so far is probably also one of the highlights of my life and it came about through complete serendipity and luck. And I know that's really annoying for people who want to get into these roles, but it's genuinely the truth. I was living in Australia. I'd just published my second book, which is called One Medicine, all about how animals can help us understand human disease better and navigate the science of medicine.
And I had an email out of the blue from somebody I hadn't spoken to in probably 20 years or so. I studied in Cardiff University and one of my flatmates was a chap called Tim and Tim always wanted to work in the creative arts. He loved English literature and it turns out that Tim became a very famous playwright. And the reason he was ringing me was because he'd written a new play
which was about the origins of the National Health Service, about the life of Aneurin Bevan, and he wanted some advice about some of the medical aspects of it. And if I'm honest, I spoke to him via email, via the phone. I didn't think a huge amount of it, other than it sounds great, I'd love to be involved. And I absolutely didn't realise at all that this was a huge national theater production starring Michael Sheen, who was going to be Aneurin Bevan.
And before I knew it, I was in this very uncomfortable position in the rehearsal studios in the National Theatre in London, chatting to the cast, including Michael Sheen, advising on props and how people should move after having operations, as well as the history of medicine, because it was set back in the 20s, 30s, 40s, 50s, 60s. So it was a fascinating role and one I really enjoyed, really loved.
And that then led to some other medical advisory roles, including very early at the minute, but I'm helping out with some of the plot lines of Casualty, which are not out yet, by the way, so you can't blame me for any of them, as well as a few other TV things and some Radio 4 comedy panel shows as well, one called Best Medicine, for example. So yeah, fascinating bit of my life that I never expected to happen at all.
Naman Julka-Anderson (21:36)
Have you ever had imposter syndrome? Or doubted your abilities or thought you're not good enough? I like there'd a lot of people listening to this thinking, I'd love to do that, but there's always something stopping them.
Matt (21:45)
Daily, you know, now, yesterday, tomorrow. And, you know, it's a double edged sword, isn't it? It makes me, you know, I have times when I'm in an environment where I'm talking in a conference or a keynote lecture or in the National Theatre. And yes, I may appear, you know, on stage as a polished talk, but I'm in the toilets, you know, before and afterwards
you know, talking to myself, thinking what on earth am I doing here? And that's the bad bit. The good bit is it makes you, you know, do that much extra preparation or go that bit further, for example. And, you know, the older I get, the more I realise we're all, you know, we're all on a stage, really putting on a face, acting in the role that we're in, even if it's where we belong to some extent. So I don't think there's any adults really in the world
and as soon as you realise that it makes everything a little bit easier.
Jo McNamara (22:38)
Thank you for being so honest, because I absolutely can recognise lots of my colleagues who have imposter syndrome, who I know are just absolutely amazing. You just think, yeah, go for that opportunity. And they're like, no, I can't do that. So it's really nice to hear that someone has established as you that that is still something that you kind of have to come to terms with and have to get over. It's really important to kind of put that out there.
Matt, in terms of kind of ⁓ essentially the work that you do with public engagement and also, you know, still working very clinically, lots of people at the moment are maybe discussing some of the issues around the NHS, know, failings. What do you wish that maybe we did differently in the NHS with all of your expertise and also kind of thinking from that public facing perception role that you have?
Matt (23:36)
Well, the truth is the problem of the NHS is very simple in many ways. I've mentioned Anirun Bevan who is the politician from Trearddur in Wales, not too far from where I'm talking to you from now, and he created this moral revolution really in saying healthcare for all at the point of need. But the truth is when he was standing in the Welsh Valleys arguing that, it was much easier
because there were very few interventions you could kind of have. There was antibiotics, steroids, there were a handful of operations, but there wasn't CAR-T therapy, which costs a third of a million pound and actually works. There weren't complex joint prostheses, which cost tens and tens of thousands of pounds. There weren't the diagnostics and the MRIs and the PET scans, then the complexity of medicine.
And so, you the NHS as it stands now was almost never designed to deliver what we expect to be delivered today. And the truth is, in order to make that sustainable, there's only three options, actually. You could do as they do in Denmark and tax a lot more. You we already tax quite a lot, but in Denmark they tax more and so there's more money in the system. Or you could ration
as they do in France for example or you could collaborate as they do in Australia who collaborate with private industry in order to offload the public system. So in my mind there's really only three options which is tax more, raise more money for it, ration more or collaborate. I think the problem in the UK is we actually do all three but we're not honest about it.
You know, we tax a lot, but perhaps not enough for what we want. We already ration, but without transparency. Just look at NHS dental services, for example. It's strange how teeth are not health, but every other bit of your body is. And, you know, there's already collaboration in many ways with industry, but again, we're not transparent about that. So I think the one thing I...
I really would want is honesty about those three options and honesty about how we're going to go about it. You know, I still think that the NHS system is probably the best option that's there. It's a terrible option, but it's the best we have, a bit like democracy. Although I have worked in the Australian system and the way that they collaborate with private industry is done in quite a good way in many ways in that.
Those people who have private health insurance, have the same level of care. They have the same surgeons and doctors and nurses and treatments. It's just they have slightly better food and a carpet on the floor, for example. And what that allows is for the public system to be offloaded so that the treatment times in the public system are far, far less than we have here. So I don't know what the right answer is. And in a way, I kind of don't care which of those three systems
three options happen, but what I really do care about is having an honest debate about those three and moving forward with them.
Naman Julka-Anderson (26:36)
It's interesting the collaboration part. So in radiotherapy, we have these collaborations quite often. So you might have a three linear accelerator department and two of the machines have been privately funded, but they can only work nine till five. And the NHS machine is on from, know, half seven till whenever it needs to. I remember I've worked somewhere before where you had to shift the patients if you're running late. And then actually equally, I think people who can afford private or have private insurance, they don't realise that
the wraparound care isn't there. So if you have head and neck cancer, for example, all of that allied health professional care, the speech and language therapist, the dietitian, the physio, if there is one, the therapeutic radiographer, then the clinical nurse specialist, you don't get any of that. You might have an amazing surgery, yeah, but everything else is down to you to figure out. if there's a problem in that surgery, you're blue-lighted to an NHS hospital to go through A&E on the NHS. And people don't understand this at the minute and...
Matt (27:05)
Yeah. Yeah.
Naman Julka-Anderson (27:29)
I think similar to what you were saying, it really frustrates me when people say the NHS is rubbish. But actually, as you said, it hasn't grown in the way it needs to. And yeah, it is actually pretty amazing for what you get compared to if you go to America. To have a baby, it's 60,000 to 90,000 dollars and that's not even if there's any complications.
Matt (27:47)
Yeah, and the truth is the NHS isn't a single thing, you know, it's not even a single thing in terms of where you work locally, you can have some services which are absolutely world leading and super efficient and some services which aren't. And that's before we even look about the complexity of how it's delivered in the different nations in Scotland or Wales or England. We have no commissioning, for example, here in Wales, and that's good and bad.
We don't have a healthcare inspectorate in the same way as you do in England and that's good and that's bad. So, you know, I think the NHS can be absolutely amazing. And where I work in intensive care, you know, we don't have a waiting list. There's no such thing as a waiting list. The waits are measured in minutes or hours rather than anything else. And at the same time, we see people, as you say, being transferred from private industries
into intensive care because they've become critically ill and that just wouldn't be possible in those other sectors. So, you know, it's so incredibly complex, but I think what we need more than anything is honesty around those conversations from politicians and from people working in the system too. There's major changes in Wales coming up, for example, in the next election cycle in May, we're likely to have a different government compared
with 25 years of labour who's been in Wales. And I just hope that with any change throughout the UK, there'll be a change to that almost aggressive transparency, which is, think, what we need.
Jo McNamara (29:20)
Wouldn't it just be amazing if every government just came together, every political party and said, right, OK, this is what we're to do with the NHS, rather than every time we get a new political party in, you have to think, right, we're going to change it. And you're like, oh, no, anyone who works in the NHS is like, it's come in, it's come in, there's going to be change, there's going to be reform around X, Y and Z. And you just think we've only just gone through all of that. And it's so it's so wasteful of money and time and resources, isn't it?
Matt (29:48)
Yeah and you know there's always hope but at the same time I think I counted the other day and there's 27 different kinds of plugs in this world so you know even trying to synchronize something as simple as how you charge your phone you know you need 27 different plug adapters for all over the world so it's a wicked problem genuinely but let's hope there's at least progress.
Jo McNamara (30:21)
What do you think people would be most surprised about if they were to go into an NHS intensive care? What is it that when you were kind of maybe doing your training and things, what was it that kind of surprised you that you just didn't think existed or happened as part of intensive care medicine?
Matt (30:39)
I guess it's implicit in the word. There's not many medical specialties which actually have the word caring. There's palliative care, there's intensive care. And the thing that probably attracted me in those early days to intensive care, which were the monitors that go beep and are very brightly coloured and the exciting procedures and the expensive equipment and drugs, all those things are really important. But you can't always save a life.
But you can always save a death. There's always care if there's not always treatment and I guess the older I've got the more I realise the importance of that element of things actually. It's easy to get blinded by the technology and the complexity but it's the care which is still at the center of it. I guess the other thing that people might be surprised with is that ventilators are just plugged into plug sockets.
You know, it's also strange things like that. You'd think there'd be some really complex safety system of it being hardwired and then unable to be unplugged, for example, but no, they're just bits of equipment which you plug in and turn on.
Naman Julka-Anderson (31:44)
Can ask a bit of a silly question. You talked about ICU. What's all the other acronyms? ITU, HTU, all of these other bits and pieces, and how do they differ?
Matt (31:52)
Yeah, I guess intensive care is quite a new specialty. It was only born in 1952. It was born in a viral pandemic in Copenhagen, which is the Copenhagen polio viral pandemic. So it's still quite a new specialty finding its its feet. And in fact, it was only a second viral pandemic, the COVID pandemic, where the word intensivist was put in the dictionary. So it's still quite a new specialty. And I think
the words have kind of been as a result of that. The word ITU, Intensive Treatment Unit or Intensive Therapy Unit. Well, I've just said sometimes there aren't treatments actually, but there's always care. So I probably prefer the acronyms of ICU, Intensive Care Unit. And actually we've now moved more and more to the phrase Critical Care Unit as a new way to put that.
Then we've got the HDU, the high dependency area, the high dependency unit. And that is because the way that we talk about levels of care in an intensive care unit, at least in the UK, we talk about level two or level three care. And what this basically means is if you're on a ventilator, on a breathing machine, on a life support machine with a tube down your throat, you're classed as a level three patient.
Or if you're on kidney dialysis, for example, you're a level three patient. And yet if you're on a different kind of machine, if you've just got high flow oxygen or you're on non-invasive ventilation, or you're just attached to some inotropes or vasopressors, you're classed as a level two patient. And it used to be that you have different areas that deliver those different levels of care. So the HDU typically would have that level two care
and the ICU or ITU would have that level three care. Actually, certainly in the unit I work in, it's increasingly common now to have that blended because it's recognized that just because you're on a ventilator, it doesn't mean you're any more or less complex in many ways. Sometimes the trickiest patients to manage and the most complex are the ones who aren't on ventilators. But it's all around staffing ratios and commissioning amounts and so on.
But to keep it simple I think critical care unit probably is the best overall term.
Jo McNamara (34:12)
Matt, how do you and the staff who work in those kinds of settings look after themselves? Because I would imagine there will be days that you go home and just, I don't know, crack open a beer or have a glass of wine or if you don't drink think, right, I'm going to have a hot bath and just shut out the world. How do you look after yourself when work can be so stressful but...
also there is a tendency with healthcare professionals that we kind of don't recognise it anymore. It's just part and parcel of a day's work and you don't maybe have those points in your life where you go, gosh that was a really hard day because every day is hard. I don't know.
Matt (34:49)
Yeah, well, you know, the truth is intensive care is what I describe as a perma-crisis. So yes, every day is a day where there's the toughest things that ever happened in someone's life. But at the same time, you know, everyone's job is super stressful and stress is when you go outside of your limits or outside of your training or the support structures aren't there. So yes, it's a perma-crisis, but we try to bring pools of order to that
sea of disorder. So we have checklists for those really complex perma-crisis things. You're never making decisions alone. It's always a team sport, whether it's the colleagues that you run by complex moral or ethical decisions, or whether it's the, you know, super skilled nursing staff who can work together on those resuscitations. I'm not saying it's not stressful, but it's almost a constructed
safety blanket in this perma crisis that we have and you know there are different ways that different people deal with it. think Intensive care probably attracts those people that you know when I have a really stressful day or see something very sad it often doesn't make me sad or stressed it makes me appreciate life it makes me realise that I know that
the flat tire that I had in the morning, it pales into insignificance when you look after a 19 year old who is walking along the edge of their life after a car accident, for example. It makes those other things just less important. That also comes with disadvantages. Maybe it means when I come home and my wife says, she's got a really sore leg, perhaps I'm not as compassionate or empathetic
as I should be. So I think it does change you, but for me it doesn't burn me out, if anything it burns me in. But there's no one way to deal with that. For me, finding out more about somebody, for example, or following them up in follow-up clinic when they survive, that is the thing which keeps me grounded and burns me in. It's not having a yoga ball in the corner that I can go and relax on.
For other people, yeah, they throw themselves into sport or music or family and other things, but I think it probably does select the people who take a slice of intensive care and makes you appreciate the beauty of your own life.
Jo McNamara (37:22)
Matt, we could ask you questions all night. It's great having your perspective on things, so thank you for joining us. We always end Rad Chat with top tips, so we have really diverse listeners, members of the general public, healthcare professional students. What top tips would you like to leave the listeners with?
Matt (37:41)
Wow, top tips. Yeah, I guess I ended my first book with a quote which I then updated in the last book actually. So I'll give you both of them perhaps and you can choose which one you'd rather. My first book ended with the phrase, if anybody wants some advice about going into healthcare or working in intensive care, it's pretty simple. Be kind, ask questions, work hard. So that's how number one finished. And then actually...
By the time I came to number three, I subtly changed that to, it was still work hard, be kind. But it was that I now prefer questions rather than answers. So I used to love answers to tricky questions and now I probably prefer the questions. So that's the tips that I'd probably leave your listeners with.
Jo McNamara (38:24)
Amazing. Thank you so, so much. It's been great to have you on and a real pleasure to have you, your kind of perception of all of healthcare as well. Really interesting. Thank you. So a huge thank you again to our guest, Professor Matt Morgan, talking about his role as a consultant in intensive care and his experiences. Thank you all for listening to Rad Chat with myself, Jo McNamara and Naman Julka-Anderson. Our next guest feature will be Noreen Hawkshaw, Laura Ashley and Jackie Crew as part of our Education and Workforce Development series.
Matt (38:35)
Thank you both.
Jo McNamara (38:53)
talking about dementia and improving cancer outcomes. Thank you all for listening.
Matt (38:58)
and then we'll know what you mean.
Jo McNamara Rad Chat Host (38:59)
So what do you do now? Well you can use this episode as part of our free continual professional development accredited content which offers flexible learning that fits your busy schedule. Just check out the show notes for the reflective questions, links to literature and resources and link to the completed form to receive your accredited certificate.
Naman Julka-Anderson (39:18)
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Jo McNamara Rad Chat Host (39:28)
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Naman Julka-Anderson (39:51)
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Jo McNamara Rad Chat Host (40:16)
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