Who Should Be Responsible for Care of the Critically Ill Surgical Patient?

In an article in this issue of the Archives, Trask and Faber¹ conclude that "surgeons are relinquishing their responsibilities" in the direct care of their critically ill postoperative patients and attribute this trend to several factors. Surgeons may feel uneasy in using the newer mechanical ventilators and other recent advances in intensive care unit (ICU) technology. We can be put at a financial disadvantage if we insist on providing postoperative care for our critically ill patients; the time spent in the ICU can be spent to greater monetary advantage in the operating room. Referring physicians may elect to direct their referrals to surgeons who turn postoperative care back to them so that they can then separately bill for that care. Medical staff concern about professional liability, or perhaps concern about maintenance of consultation fees, can lead to restriction of surgeons' activities in the ICU; in some hospitals, Swan-Ganz catheters can