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Are Intensivists Safe?

Gordon D. Rubenfeld, MD, MSc; and Derek C. Angus, MD, MPH
[+] Article, Author, and Disclosure Information

From the University of Toronto, Toronto, Ontario MHN 3M5, Canada, and University of Pittsburgh School of Medicine, Pittsburgh, PA 15261.

Potential Financial Conflicts of Interest: Drs. Rubenfeld and Angus are practicing intensivists.

Requests for Single Reprints: Gordon D. Rubenfeld, MD, MSc, Program in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D503, Toronto, Ontario M4N 3M5, Canada; e-mail, gordon.rubenfeld@sunnybrook.ca.

Current Author Addresses: Dr. Rubenfeld: Program in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D503, Toronto, Ontario M4N 3M5, Canada.

Dr. Angus: University of Pittsburgh School of Medicine, 614 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261.

Ann Intern Med. 2008;148(11):877-879. doi:10.7326/0003-4819-148-11-200806030-00010
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Intensivists have an identity problem. We do not perform unique procedures, such as coronary angioplasty or endoscopy. We used to take pride in our skills placing and interpreting data from pulmonary artery catheters, but this art is dying rapidly as the evidence mounts against its utility (1). We do not have an organ focus, as do neurologists or nephrologists. Many of us are internists, but others are pediatricians, anesthesiologists, neurologists, and surgeons. Despite this identity crisis, critical care medicine has not faded into obscurity but rather is enjoying a period of focused attention and popularity. Among the reasons are recent epidemiologic studies that emphasize the burden of critical illness and prominent, if controversial, clinical trials that are finally creating an evidence base for our practice (25). Of note, we have attracted the attention of payers and quality assurance agencies, primarily because of studies showing that organized staffing by intensivists improves the outcome of critically ill patients (68).



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