The Relationship between the Surgeon and the Intensivist in the Surgical Intensive Care Unit

Conflict between the surgeon and the intensivist caring for the patient in the SICU is easily understood. The intensivist is motivated by increasing evidence that a team approach, evidence-based medicine, and a compassionate approach to the relief of suffering are the goals of an ICU. This is substantiated by many studies showing that these approaches decrease length of stay, hospital costs, complications, and mortality. The surgeon is motivated by wanting to cure the patient, and is used to being the one in charge-"the captain of the ship." Most are probably unaware of the studies showing the effect of a dedicated intensivist as far as patient outcome. The key for both is communication. For the intensivist, this includes making sure that adverse events are reported in a timely fashion, that important decisions are discussed, and that the surgeon is included in the team. For the surgeon, this means being willing to discuss rather than dictate, and considering different approaches.