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April 2016

Contemporary Multidisciplinary Care—Who Is the Captain of the Ship, and Does It Matter?

Author Affiliations
  • 1Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California
  • 2Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
JAMA Surg. 2016;151(4):309-310. doi:10.1001/jamasurg.2015.4421

“But it’s my patient, I’m the one who has to answer to the family and who gets sued.”

This is the battle cry most often heard in the intensive care unit (ICU) when physicians reach loggerheads about who should be directing care. The captain of the ship doctrine, although now largely discredited in medicolegal status, was first applied to medical practice in McConnel vs Williams.1 We argue that times have changed and changed permanently. In an era of team-based care, the question of who is captain of the ship is too often a distraction and, more importantly, does not contribute to good patient management.