To the Editor.—I wish to comment on the provocative editorial by Dr Sugerman (Archives 1982;117:391). Compared with a well-reasoned, thoughtful editorial by Skillman that appeared in the Archives previously,1 Dr Sugerman's article is, at best, a plea for "turf protection." I also got the impression that Dr Sugerman is unable to look beyond university medical centers, which traditionally have ignored organization and supervision of critical care units. The survey by Machiedo et al, in fact, supports this observation.2 Less than 50% of the intensive care unit (ICU) directors at academic centers answered consultations. Almost half (47%) of the respondents stated that there were no formal lectures on topics specific to critical care for the resident staff.
The key to house officers' learning is supervision at the bedside. Without any real involvement with patient care, ICU directors traditionally serve as referees between various consultants, nurses, and respiratory therapists.
PURI VK. Surgeons and Intensive Care Units. Arch Surg. 1982;117(12):1614. doi:10.1001/archsurg.1982.01380360084015