Ownership

When a surgical patient goes to the intensive care unit, her treating physician and team changes to the ICU attending and team, regardless of who was in charge before. This can sometimes create conflicts in patient ownership. A surgeon who takes a high-risk patient to the OR and sends him to the ICU afterwards relinquishes control over the patient's care. If a patient has a complication and goes to the ICU, the surgeon has to step back and let us fix his problems. Obviously this distinction isn't so black-and-white. But it can lead to too many cooks in the kitchen.

We put a lot of weight into what the primary surgeon and team want. After all, they were at the surgery, and sometimes, they have additional information. For example, a patient whose tissues are extremely fragile in surgery will be at higher risk for wound dehiscence. This may not be reported but if a patient has a rocky post-op course, it may become relevant. The surgeon also knows the patient's anatomy the best, understands his own surgical strengths and weaknesses, and feels incredibly invested in the patient's outcome.

Yet it's important not to let the primary surgeon run the patient's ICU course. Critical care medicine is its own subspecialty. A couple decades ago, most ICUs were run by physicians who were not specially trained in critical care. The poor outcomes at that time lead national agencies like the Leapfrog Group to advocate ICU physician staffing. Whether a patient has medical problems, traumatic injuries, or post-operative complications, we can take care of their multiorgan failure, resuscitation, management, and treatment. We cannot expect general surgeons to stay up-to-date on intensive care medicine. Dedicated intensivists should be able to bridge surgical concerns with critical care medicine to take the best care of our patients.