An unfortunate trend has appeared in the United States: surgeons are relinquishing control of their surgical intensive care units (SICUs) to directors of critical care medicine affiliated with departments of medicine or anesthesiology.1 There is no question that internists and anesthesiologists are valuable consultants in the care of the critically ill. However, they often lack an awareness of the urgency to drain pus or excise dead tissue. Similarly, nonsurgeons rarely understand the importance, or have expertise in the management, of nutritional repletion for surgical patients.
As nonsurgeons take over the management of surgical patients in the SICU, less surgical house staff will be trained in the intricacies of ventilator management, Swan-Ganz catheterization, hemodynamic support, etc. By abandoning their responsibility for postoperative management, surgeons will become mere operating room technicians, and there will be fewer physiologically oriented surgical role models for students and house staff. It is absolutely essential that surgical