Episode 129

Hello Reader,

Communication Skills in Critical Care with Dr. Tessie October

This week on the podcast I spoke with Dr. Tessie October, a pediatric intensivist and palliative care physician. Her research records real family meetings in the pediatric ICU to learn what makes those conversations go well. She is also Distinguished Faculty and a board member at VitalTalk, and the two of us have taught communication skills together for more than ten years.

We started with why communication matters so much in critical care. Talking with patients and families is the most common procedure in the ICU, yet most of us learned it by watching. For central lines and ECMO, we practice in simulation and get observed first. Our shared view is that conversations deserve the same intention. When they go well, the team learns who the family is and what they value, then turns those values into a treatment recommendation. When they go poorly, families feel unheard and stuck, patients stay in the ICU without a plan, and the team carries moral distress and conflict.

Then we talked about her recordings. Clinicians spoke about 80 percent of the time, which did not surprise her. What did surprise her was how often a strong empathic statement was undone by the next word: "This must be so hard, but we need to make a plan." The "but" cancels what came before it. She also found that the conversations that went well took less time. In those meetings the clinicians and the family moved at the same pace, instead of the clinician walking ahead while the family asked to go back. Her mentor, Dr. Bob Arnold, compares the ICU team to a band: families can tell when the players have never played together, and they start to lose trust in the whole system.

​VitalTalk is a nonprofit that teaches these skills through practice, not lecture. You work with trained actors, hear first what you did well, choose what you want to work on, and go back into the scene to try again. As Tessie put it, if watching were enough, she would be an excellent tennis player.

Her one skill for your next family meeting is the question "What else?" The first answer to "What are you most worried about?" is usually the surface one. "What else?" brings up the deeper fear or hope, and it gives the clinician a moment to think about how to link those values to a recommendation.

Communication is a procedure, and it improves the way other procedures do: through deliberate practice with feedback, not years of exposure. Families forgive a clunky sentence when the curiosity behind it is real.

These conversations happen every day, and families remember them long after the ICU stay. They deserve the preparation we give to rare, high-acuity procedures.

Here's my question for you this week: in your next hard conversation, where could you ask "What else?" and leave room for the answer?

Tessie and I are teaching a full-day VitalTalk communication skills pre-course for critical care clinicians on Saturday, March 13, 2027, the day before the SCCM Critical Care Congress opens in San Diego. It is built for physicians, advanced practice providers, nurses, respiratory therapists, pharmacists, social workers, chaplains, and trainees. You can learn more about VitalTalk at vitaltalk.org, and the free VitalTips app has their talking maps for review right before a family meeting.

Tell us what you'd like the podcast to take on next at hello@transforminghealthcarecoaching.com.

🎧 Listen to the podcast sneak peek episode below and listen to the full episode on YouTube, Apple, Spotify, Podbean, or Amazon Music.

Lead well!

Lilly

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