To the Editor.—In the September 1990 issue of the Archives, Trask and Faber1 presented the sobering but unsurprising observation that, in three quarters of non–University affiliated hospitals, surgeons no longer provide the principal intensive care unit (ICU) services for their patients. The accompanying commentaries by Higgins2 and Holcroft3 decried this abdication of responsibility and attributed it to financial and medicolegal influences. But their commentaries overlooked two more insidious and, over the long term, far more destructive influences—lack of respect by many surgeons for their colleagues who choose to focus their careers in critical care, and surgeons' ambivalence concerning the need for dedicated ICU staff.
These destructive influences are manifested in curious ways. Some surgeons consider their "intensivist" colleagues to be mere "drip doctors" and "bed finders." Others warn trainees that careers in surgical critical care are "dead ends" and advise them to identify at least additional,