I recall that as a child I was always fascinated by Kinder Surprise products.  The excitement of having milk chocolate and building my own toy!  I would put the parts together, and then pull them apart to study the design behind it.  Functioning toys despite the limited space and parts! The creative and engineering design behind these creations is amazing.  Even as an adult, I am still curious about what companies and people go through to present a performance, a product or a service.

I come to learn that many Respiratory Therapists have a similar interest in understanding processes.  Perhaps that’s what makes us skilled troubleshooters, innovators, and effective team players in interprofessional settings.

One way to nurture this strength is to ask questions.  As children we were more curious and comfortable asking questions.  We need to revive that sense of curiosity to promote growth.

Here are my 5 personal views and advice on asking questions.

Create a supportive space for learning
I remember on my first day of clinical rotations at my base-site hospital, our Practice Lead said: “You know the saying that there is no such a thing as a stupid question?… Well, that’s wrong”.  I looked around the room and saw that the same expression of shock and surprise on the face of my fellow classmates.  I hope you have a supportive culture at work or school which encourages a safe space for growth and learning.  Allow your students and new hires to ask their “stupid” questions before they resort to “trial and error” on real patients.


Asking questions is a not a vulnerability but an indication of caring.

Whether you are a student or experienced RT, put egos and feelings aside and ask questions.  Asking questions is not a sign of weakness but demonstrates a willingness to learn.  There is danger in the mentality of “fake it until you make it”.  Confidence comes with competency.  We should ask questions to learn and to better master the knowledge or skillset.  Learn, incorporate new learning in practice, evaluate with feedback, modify and repeat.


Questioning a routine practice is a growth opportunity and not a threat.

When questioned about a routine practice and the answer you come up with is “that’s the way we have always done it”, know that you either need to review the support for that guideline/process or you need to re-evaluate how it is done.

I have had staff RTs express that they used to follow the advice of experienced RTs and that “younger” RTs need to question everything before they do something.  Please don’t view this as a criticism, threat or laziness.  This is a learning framework for younger generations who have a lot more available resources and opportunities to be involved in decision making.


Timing of questions

Asking questions, just like any other form of communication, can be impacted by the timing, tone, intent, importance, and perception.  If you are watching your preceptor in the middle of a complicated code and you notice a unique LMA insertion technique, the question about the technique probably can wait until the patient is more stable and/or during the debrief.  If you are asked to put a BIPAP on an unconscious patient and you have valid reasons to be worried about airway protection, then your questions require more urgency.
As always, be kind to others and ask questions to learn something and not to show off your own knowledge or to make a statement.



Talk to people outside of your team, unit, hospital, and even profession.  You will be surprised about the different perspectives on a subject matter.  This is one of the reasons why I enjoy attending conferences that are intended for RTs and those that for various Healthcare professional audiences.


“Science is fun. Science is curiosity. We all have a natural curiosity. Science is a process of investigating. It’s posing questions and coming up with a method. It’s delving in.”
-Sally Ride (American astronaut, physicist, and engineer).

These are my personal opinions and views.  Now let me ask you!  What are your thoughts? How have you created a safe learning environment for your students, new hires and experienced staff?  What advice do you have to share with others about asking questions? Do you have a story to share about how an inquiry helped with patient care?  Leave a comment and let me know!


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Less coffee?? You must be nuts!


Photo by Christian Joudrey

As I sit down with patients and discuss smoking cessation, I actively try to stay open and to hold back any judgment. I hope for an honest discussion on their part as well. I share with my patients that everyone’s journey is different and there is validity in their struggle. Smoking has a physical, social and psychological aspect to it.
I am not a smoker and have never been addicted to nicotine. Could I truly be empathetic to a smoker? Sure! I believe we all can be more empathetic without going through the same experience by listening to people.
Coffee is my addiction.
I have been drinking coffee since my first year of undergrad. It began as a necessity to allow me to read through pages of Kinesiology and Psychology notes at York University. Drinking coffee continued even post-graduation. Again, it became my crutch while studying respiratory therapy at school, during my clinical rotations and while working as a staff RT at an acute care hospital. Even when I stopped working in the acute care setting, every day I drank a total of two medium Tim Horton’s cups of coffee.
As a self-awareness and reflective process, I decided to limit my caffeine.
For the past three weeks, my caffeine intake has been limited to decaffeinated coffee. Even within the first three days, I experienced some expected changes. I felt more tired in the afternoons. My heart rate was lower and didn’t have the sensation of beating at the “top” of my chest. My ongoing general and social anxiety has reduced to almost non-existent, and I urinate less frequently.
I have also experienced two elements that I did not predict or expect. First, I expected to have some irritability or withdrawals but experienced none. This may be due to my daily consumption of decaffeinated coffee as it contains a small amount of caffeine.
Second and unanticipated to me, I began to have more dreams! In the past, I would wake up once or maybe twice a week knowing that I had dreamt. Now I wake up every morning, knowing that I have! It is my guesstimate that with a medium size coffee in the morning and one in the afternoon, caffeine’s six-hour half-life never had a chance to clear my system in time to allow me a restful sleep.
Literature and studies go back and forth on the benefits of coffee, and this post will not attempt to cover that information. The goal of this post is not to change your drinking habits (unless you experience general anxiety associated with an increase in heart rate and have a pattern of low quality sleep).
What did I learn from this “experiment”? In this self-awareness exercise, I had the assumption that greatly reducing my caffeine after 15 years would be very difficult. Also, that it would lead to severe withdrawals over the first few days. Luckily that was not the case.
I did not decide to suddenly stop drinking coffee and instead, settled for decaf because I really enjoy the smell and taste of coffee! Sometimes it is hard to change the social, lifestyle and behavioural patterns and routines.
Did this experience lead to a groundbreaking insight and further deepen my empathy with my patients who smoke? The truthful answer is not really. I felt that I already had a supportive mindset toward my patients. While this exercise did not necessarily make me a better clinician, I do enjoy the personal benefits of limited caffeine consumption. I still occasionally drink regular coffee but almost all my coffee and tea is decaffeinated. The reduced heart rate and associated lower anxiety symptoms and increased dreams are great benefits.
I encourage you to identify and challenge some of your held beliefs and routines. If you are on the right path, then it will re-confirm your choices. If not, you can explore new possibilities.
Through self-development, hurdles, struggles, and victories you can be more aware of the processes involved in change. Sometimes awareness itself can make one more empathetic.

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The World Health Organization (WHO) has provided a list of recommendation on how to be healthier.  Just like everyone, as healthcare professionals (HCP), we can be healthier.  Through my respiratory therapy blog, I try to support the development of HCPs.  While the recommendations on this post are not RT skill set or knowledge based, it may still be beneficial at the core level.


**Legal stuff: The mentioned links are some of my personal references.  Please consult your healthcare team before making changes.

  1. Eating a healthy Diet.
    >Internal Link: Respiratory.Blog post on Nutrition:
    >External Link 1:  WHO’s Nutrition page
    >External Link 2:  Meal Ideas for breakfast, lunch, supper and Snacks by Government of Canada. Visit the website for details
    Accessed Sept 02, 2018
  2. Be physically active, every day, your way. 
    >Internal Link 1: Respiratory.Blog post on improved physical health
    >Internal Link 2: Respiratory.Blog post on foot health
    >External Link: Goal Setting Worksheet by ParticipAction

    Goal Setting Worksheet by ParticipAction: Accessed Sept 03, 2018
  3. Get Vaccinated.
    >External Link: World Health Organization Documents

    Infographic: Vaccines Work Date modified: 2018-04-20 Accessed Sept 3rd, 2018
  4. Don’t use any form of Tobacco.
    >External Link 1: WHO Quitting
    >External Link 2: WHO Tobacco
    >External Link 3: WHO Smoking Cessation
    >External Link 4: A Guide for Tobacco Users to quit

    WHO;jsessionid=E4DE553F0987B9116BC28D1DA16B894F?sequence=1 Accessed Sept 03, 2018

    >External Link 5: Smoker’s Helpline

    Smokers’ HelpLine Canada
    Accessed Sept 03, 2018



  5. Avoid or minimize use of alcohol.
    >External Link 1: WHO’s Alcohol page
    >External Link 2:  Canadian Centre on Substance Use and Addiction

    Drinking Guidelines
    Accessed Sept 3 2018
  6. Manage Stress for your Physical Health and Mental Health
    >External Link 1: WHO. Mental Health: Strengthening Our Response.
    >External Link 2: Useful resources from  Stress Relief for the Healthcare Professional (pdf document).

    Stress Relief for the Healthcare Professional
    Accessed Sept 3 2018
  7. Practice Good Hygiene
    I know the recommendation is based on over all hygiene, but I am going to include a link more specific to hand hygiene:
    >External Link 1: Hand Hygiene Module by Public Health Ontario
    Accessed Sept 03, 2018
  8. Don’t speed or drink and drive
    >External Link 1: WHO. Road Injury continues to be one of the top 10 causes of death (2016):


    >External Link 2:  Safe Driving Practices by Ontario Ministry of Transportation

    Ministry of Transportation
    Accessed Sept 3 2018
  9. Wear a Seat-Belt when Driving and Helmet when Cycling
    >External Link 1: WHO Injury Prevention
    >External Link 2: Road Safety in Canada
    >External Link 3: Bicycle Safety by Ontario Ministry of Transportation

    Bicycle Safety
    Accessed Sept 3 2018
  10. Practice Safe Sex
    >External Link 1: WHO Reproductive Health
    >External Link 2: Health Canada – Sexual Health
    >External Link 3:  Sexual Health Ontario

    Sexual Health Ontario
    Accessed Sept 03, 2018
  11. Regularly Check Your Health
    >External Link 1: Routine Checkups by Health Link BC
    >External Link 2:  Well-Visits by Caring for Kids (CPS)
    >External Link 3: Choosing Wisely Canada
    Sept 03 2018
  12. Breast Feeding: Best for Babies
    >External Link 1: WHO. Breastfeeding page.
    Accessed Sept 3 2018

    >External Link 2: Caring for Kids (CPS). Breastfeeding

    In Summary:


    My hope is that you will use the WHO recommendations to improve as an individual and as a healthcare professional.

    Personally, I have begun incorporating more physical activity in my days, including more frequent visits to the gym.  I find exercising refreshes my mind, gives me more energy, and makes me feel healthy.  Also,  the upcoming 5k walk/run on the first day of RT Week, in support of Respiratory Therapists Without Borders, has been another motivation for me to get back in shape.
    Planning for healthy meals has allowed me to save money, eat healthy and  reduce unnecessary waste.  By planning meals prior to grocery shopping, I tend to stick to the grocery list and am less influenced by delicious and tempting junk food.  When I take my lunch to work fewer excuses to eat unhealthy.
    Over the last 4 years I have recognized the importance of a healthy mental and physical state.  I experienced a burn out post graduation following a few months of over-work at a job which lacked a nurturing environment and supportive leadership.  This was exacerbated by my lack of proper sleep quality, healthy eating, sufficient physical activity and poor time-management.  Since then, I have learned to be more mindful of my physical and mental status.   While I am far from being perfect and continue to make mistakes along the way, I still try to be more self-aware, more mindful and goal oriented.

    Let’s continue our journey in becoming quality HCPs.





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Social Media

As some of you know, I used to have photography social media accounts and now have focused my energy into my respiratory therapy blog. This involvement with social media for these years have brought an awareness to some of the mindsets, trends and external observations to online presence. I would say with confidence that now there is more noise than useful information. If people didn’t see or follow the evolution of Internet and social media, they may mistake the online “noise” as the true front of these online individuals and companies. While I do not consider myself an expert or a role model in this area, my involvement in this field has allowed me to identify individuals who have more realistic views of the online “process”.

In the following video Gary V. talks about one’s willingness and drive to dedicate “spare” time to achieve the desired outcome. Pay attention to how his advice is focused on what individuals truly want versus what they should want due to the influence of social trends and peer pressure. Also that you need to enjoy being involved in the process than necessarily the outcome (as there is learning in failure as well).
Personally, I believe in actions speaking louder than words. Also that there is hard work involved in every process. There are few true “easy” ways to reach greatness. In my respiratory therapy blog I have interviewed many successful individuals in the RT field and while their journey and achievements vary, they share characteristics such as hard work, self reflection, resilience and at times unique opportunities.
I encourage you to step back and re-evaluate what truly makes you happy, and that what you do or think is in line with that mindset. Continue to grow, learn and connect.
Stay curious.
Be kind to yourself and others.


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Who is helping who?

 Last Monday I was driving through my usual path to work.  At the Pulmonary Function Test (PFT) laboratory of Markham Stouffville Hospital, my colleagues and I perform PFT, 6 Minute Walk Test, Home O2 assessment, Arterial Blood Gas and occasional Exercise Induced Asthma test.  In the gaps between tests we provide patient education including Asthma, COPD and Smoking Cessation. On my drive to work last Monday around 7am, I was waiting to make a left turn when a car ran a red light and collided with the vehicle travelling in the perpendicular direction.  Because of the impact, the cars changed path and hit my vehicle. Everyone was okay. The cars had to be towed to collision reporting centre before being heading to repair shops. While I sat in the tow truck, the driver walked me through all the steps, gave me advice on what to expect that day and for the following days.  He even helped me organized all the required documents as I called my insurance company. As we were waiting for my rental vehicle to arrive, he said, “You said that you are a respiratory therapist… I have a bad habit”. He paused for few seconds and then continued… “I have been trying to quit smoking”.

Over the next 15 minutes we covered some smoking cessation information. I asked him questions and we went through some options.  He was motivated and willing.

 A few days later I was reflecting on this interaction and the conversation with him.  Sometimes you get to help someone when least expected. In my case you may get to help someone while they are helping you!  

 Yet another thought, or possibility, came to my mind.  Perhaps he asked me a question so I would talk about something I am passionate about.  Because over those 15 minutes, I was not thinking about the accident, being late for work, nor the hassles of fixing my car. In that time I was in the zone of helping someone else.  It was such a simple way to get someone’s mind off the stress of the situation.

 Are there any patient scenarios where this “technique” can be utilized? I am hesitant to call it a technique as by interacting with patients we, the health care providers, can establish a genuine rapport which can further improve patient care.   Maybe this method or technique can be used while getting things ready for an ABG? Perhaps before or while having a patient in the PFT body box or CT/MRI machine?


 Find out what the patient is passionate about during your ongoing conversation with them.  Ask them a relevant question or advice, and watch them focus on something positive.


Let me know if you have used this approach before and how it went!

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Last weekend, October 14th and 15th, I took part in the Pediatrics Advance Life Support (PALS) course.  This is a challenging and satisfying certificate which I look forward to every few years. Completion of PALS involves review and demonstration of various knowledge and skills as both a team member and as the lead.  There are many areas of individual growth in this certificate as health care providers (HCP) deal with a wide age range of patients, from neonatal to young adolescent.  Also, the topics covered include, but are not limited to, Systematic Assessments, Respiratory Distress and Failure, Bradycardia, Tachycardia, Cardiac Arrest, Shock (Hypovolemic/Distributive/Cardiogenic/Obstructive), and Post-Resuscitation Care.  Since many health concerns of children include respiratory components, PALS offers Respiratory Therapists a good chance to review their knowledge and skill-set.

Aside from the knowledge and hands on opportunities, there is a chance to work within inter-professional teams.  PALS helps HCP’s see scenarios from different angles and roles.  By better understanding the roles, team members can more effectively understand, anticipate and participate in the flow of patient care.

Reviewing the systematic approach in PALS is a mindset that can also be applied in adult populations and during Rapid Response Team assessments and interventions.  As a new graduate, one of my biggest challenges was attending to Rapid Response Calls.  The on-call Nurse and RT would reach the bed side first and would begin the quick assessment and at times, when appropriate, would initiate the required intervention even before the attending doctor would get there.  This certificate allowed me to better identify, organize and classify the available information, better narrow down the plausible causes, and provide better interventional care.

When compared to ACLS and NRP, PALS is usually not a required certificate in job postings, thus new graduates can better stand out when equipped with this qualification.  Even for RTs who have a few years of experience, completing this certificate can demonstrate a willingness and drive to learn and to improve.

This certificate is a useful asset and thus it is my personal recommendation to RTs and other HCPs to take their PALS.


Farzad Raffi Refahi
Oct 18, 2017

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Presenting At CSRT

In 2016, I gave a talk at the annual Canadian Society of Respiratory Therapists, CSRT, Conference.   At that time I was working six days a week, running a blog, and was trying my best to prepare for the presentation.  I was excited, nervous and driven.  My presentation was far from perfect, however, I learned a lot in the process and from the self-reflection after it was completed.

Here are my top three pieces of advice for first time presenters at CSRT:

  1. Quality.
    Know more about the topic than most people in the room. Do your research but don’t invest all your time on the research component.  There will always be individuals who would know more about the topic than you would, however gather enough information so your talk would be beneficial to most people in the room.  Presenting at CSRT requires quality and professionalism.  Do your research, deliver the quality, but don’t spend the whole time sharing your research.
  2. Keep It Simple.
    Collect all the relevant information, process it and present it in few key points.  A 45 minutes long talk is a short time to discuss all your findings.  It is best to summarize or select only 3 to 5 key ideas/points, and then focus on the delivery of those points.  Keep it simple.  Present the key points without relying too much on technology.  There seems to be always some technical issue during talks (happened during mine).
  3. Practice… Practice… Practice.
    Get to know your material. I would encourage practicing enough to memorize. Practice in front of friends and individuals in the field.   Use the feedback from the practice runs and modify your presentation until it is smooth and simple while delivering the main ideas.  I videotaped my practice runs so I would identify areas that required more attention.  Don’t be afraid to connect with your audience. Get to the room that your will be presenting early or during breaks. Stand where you will be presenting, look around and get to know the room.  During your presentation don’t forget to breathe.

  Here is the link to CSRT’s  Call For Presenter’s page:

Good luck!

Farzad ‘Raffi’ Refahi HBSc RRT CRE


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