Communications to the Editor |

Captain of the Ship FREE TO VIEW

Paul E. Marik, MD, FCCP; Max Weinman, MBBS, MD
Author and Funding Information

Affiliations: 1 Pittsburgh, PA,  2 Baltimore, MD

Correspondence to: Paul E. Marik, MD, FCCP, Department of Critical Care, University of Pittsburgh Medical School, 615 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261; e-mail: pmarik@zbzoom.net

Chest. 2002;121(4):1382. doi:10.1378/chest.121.4.1382-a
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To the Editor:

Azocar and Lisbon1 should be commended for attempting to chart a course through rough and shark-infested waters. It is unfortunate that in the United States, the sickest and most complex patients are frequently managed by those least qualified to provide such care. Those of us who have trained and practiced multidisciplinary critical care outside the United States look through the portholes in dismay. It would be considered unthinkable in the United States, for a physician with no formal training in the practice and principles of surgery to perform complex surgery; yet, physicians with almost no training in this highly specialized and unforgiving discipline are permitted to provide care to patients who are at the highest risk of dying.

It is impossible to practice “part-time critical care.” Critical care requires a full-time commitment; it is labor intensive, requiring long hours at the bedside with frequent and repeated evaluations of the patient, and the capacity to respond rapidly and decisively to emergencies. This is impossible for even the most dedicated private practitioner or surgeon to achieve, as most of their time is spent in their offices and/or operating rooms far from the ICU. Consequently, the practitioner “portions off” the patients’ care to a number of organ-specific subspecialists. This usually results in fragmented and conflicting treatment strategies. Furthermore, both accountability and responsibility are also portioned off, with no physician assuming ultimate responsibility for the patients’ care. The patient then drifts aimlessly through treacherous waters, having either the physiologic reserve to swim back to shore, or being ultimately taken by the sea.

ICU patients should be managed by dedicated intensivists, be they of surgical or medical background, who have undergone specialized multidisciplinary training to provide them with the necessary knowledge, skills, and attitudes required to achieve the best outcomes for critically ill and injured patients. This is not to say the primary care physician or surgeon should be excluded from his or her patient’s care; they remain an important resource. It is but a sad reflection on medicine in the United States that it has taken industry to provide the impetus to steer our specialty on the right course. We believe that only trained and certified critical care specialists who spend at least 50% of their professional time practicing critical care medicine should be privileged to provide care in the ICU.

Azocar, RJ, Lisbon, A (2001) Captaining the ship during a storm: who should care for the critically ill?Chest120,694-696




Azocar, RJ, Lisbon, A (2001) Captaining the ship during a storm: who should care for the critically ill?Chest120,694-696
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