In Reply.—Dr Puri's criticism of my editorial (Archives 1982;117:391) appears to be based on his concept that the director of the surgical intensive care unit (SICU) must be present physically in the unit at all times. Because of our difference in philosophy, he claims that Skillman's editorial1 was "well reasoned and thoughtful," whereas my editorial was "at best, a plea for'turf protection.'" However, there are no data in the literature to support the view that the presence of full-time physicians in the SICU improves the outcome of surgical patients.
In our institution, the patients are treated closely by the house staff directly involved with their patients' longitudinal care under the supervision of the chief surgical resident and the attending physician, who also have attended the patients since admission. Overall supervision of the SICU, as well as education in critical care, is provided by surgeons well versed in the