What to believe and when to change. St.Emlyn’s at SMACC

Screenshot 2014-06-23 06.51.21My second talk at SMACC Gold. This followed on from the earlier talk on do risk factors factor  in the ED. In this talk I try and link evidence to population and individual practice. I personally ‘ believe’ that the single biggest influence on clinical practice is how we think, how we value evidence and how we use the evidence. If we are to be better clinicians then we truly need to understand that our thoughts, our interpretations and our internal arguments strongly influence what we do.

Cliff Reid does some great talks on ‘Making things Happen’. Hopefully this talk will help us understand ‘what we decide to make happen’. My good friend Scott Weingart gets a mention as he is right up there as one of the most important leaders of what we do in resuscitation.  I make a cheeky mention of his talk at the beginning of the talk, but don’t take that view second hand. Listen to his talk here, which is in my opinion one of the best from #SMACC. It’s a great talk that left me with so many questions and desires to do better for our cardiac arrest patients. I love Scott’s work as without clinicians like Scott and Cliff we are doomed to mediocrity and that would be a dreadful place to be. Yet we must also be wary of some historical lessons that tell us to be cautious and fearful of change, and not everyone can or should be at the innovation end of the curve. This talk hopefully explores why it’s so hard to make the right decision at the right time, and arguably why the right decision is almost impossible to make at the right time.

Also worth mentioning my thanks to Lauren Westfaler for some of the slides. As ever she is ahead of the game in metacognition.

So, a talk on why we need innovators, lagards, resuscitationists, cynics and dreamers. All are welcome in the #SMACC house.

Here are the slides.


If you want to hear more from SMACC then don’t forget to book you place to meet Joe Lex on the 3rd July in Manchester. Don’t forget to listen to Iain’s talk on pain and suffering and keep coming back to hear more from the St.Emlyn’s team. There is much more to come……

If you liked this lecture then you MUST also listen to Scott Weingart’s SMACC Back. Absolutely superb, I agree with pretty much all that he says but most of all I welcome the debate.

Then, and only then listen to the SMACC BACK – BACK from our podcast site.


Don’t forget to check out the Intensive Care Network for more amazing talks from SMACC, and in particular this amazing talk by Tony Brown on ‘Is the peer reviewed journal dead?’ You may also like Louise Cullen’s talk on a similar theme at SMACC Gold. Like me she is a bit of a sceptic (but also a bit of an early adopter ;-) ).

If you like this talk then go read this paper. It will scare you!


Viva la #FOAMed





  1. […] I have to agree with all the sentiments about SMACC being the best conference in the world for a blend of science and practicality for critical care medicine. I also find that SMACC conference talks delve into topics that many others do not venture. Some of them as unsexy, but important, as those around principles of research, evidence and reporting. One such was this talk I was fortunate to give at SMACC Gold titled “Why most research is wrong”. As someone who has found myself in the blended tribe of clinical researchers, I found this topic confronting. Many times over my career I have found myself influenced to change my practice, and only with the passage of time (with of course more research performed), have I and the medical community realised we have headed down the wrong track. Looking back, I clearly used to be an ‘early adopter’ of new treatments and innovation reported in the literature (see Simon Carley’s talk on ‘What to believe and when to change’). […]

  2. […] Neil asked the question of whether we can and should use these tests for the management of paediatric coagulopathy. Although not on the card it is something our haematologists are very keen on and so I believe that we will see it being used in the future. Again, I’d be interested to hear on whether other trauma centres are using it in kids. I will certainly be thinking about it when I next see a bleeding child and I think I’ll probably do it (Ed – don’t you have a view on early adoption). […]

Thanks so much for following. Viva la #FOAMed