The article suggests that the answer to the ICU doctor shortage in this country is not to train more ICU physicians - but to transfer sicker patients to "centers of excellence" phasing ICU doctors out of the smaller less 'esteemed' hospitals, and sending patients to the 'good' doctors at these so called centers of excellence.
Since there is no formal evaluation or standard for defining what constitutes a "center of excellence" and since these centers are for the most part self-named, one can't but help wonder what the author is referring to.
Ah, but I know exactly what he meant - he meant academic centers. I know that because I had to endure his type for the 14 years I worked in large academic centers. According to this arrogant buffoon, the moment one leaves the 'mecca', or the moment one arrives, skill sets magically change. Or the moment one attains a certain rank, or wears the starched white coat and tie, or graduates from the 'best' medical school, one then becomes by definition, an excellent doctor. To that I say - blahhhhhh.
ICU medicine is about instincts, good hands, rapid response and knowing how to always see the entire forest while paying attention to all of the trees. Its not about starched white coats, how well one scores on multiple choice tests, or arrogance and ego. And skilled ICU doctors, with good hands and instincts, are very hard to find - especially in academics.
Many academics are academics in large part because they would last about three days in the 'real world' of life and death clinical ICU medicine. Academics, for the most part, attracts narcissists and the arrogant or more rarely the gifted researcher/teacher - not the clinically skilled. For years I have seen so many of their patients die or be harmed unnecessarily as they blundered on, blinded by cocoons of ego to what even the ward secretaries could see - their utter lack of clinical skill.
Clinical excellence counts for almost nothing in the academic world. My promotions had nothing to do with my clinical skills - everything to do NIH grants, publications, research and smooze. For all but rare disease or the need for bone marrow or solid organ transplants or certain rare complex surgeries - academic medicine is the LAST place you want to receive your acute care - especially if you are very ill. ICU care demands excellence in clinical medicine from its ICU doctors - not titles, egos, and useless pedigrees.
Just by proposing this, this man reveals his simplistic, two-dimensional, hierarchical, magical thinking - and the reason he saw to it that he himself became an academic. It's how he defines himself. Narcissistic, insecure and lethal.
Since there is no formal evaluation or standard for defining what constitutes a "center of excellence" and since these centers are for the most part self-named, one can't but help wonder what the author is referring to.
Ah, but I know exactly what he meant - he meant academic centers. I know that because I had to endure his type for the 14 years I worked in large academic centers. According to this arrogant buffoon, the moment one leaves the 'mecca', or the moment one arrives, skill sets magically change. Or the moment one attains a certain rank, or wears the starched white coat and tie, or graduates from the 'best' medical school, one then becomes by definition, an excellent doctor. To that I say - blahhhhhh.
ICU medicine is about instincts, good hands, rapid response and knowing how to always see the entire forest while paying attention to all of the trees. Its not about starched white coats, how well one scores on multiple choice tests, or arrogance and ego. And skilled ICU doctors, with good hands and instincts, are very hard to find - especially in academics.
Many academics are academics in large part because they would last about three days in the 'real world' of life and death clinical ICU medicine. Academics, for the most part, attracts narcissists and the arrogant or more rarely the gifted researcher/teacher - not the clinically skilled. For years I have seen so many of their patients die or be harmed unnecessarily as they blundered on, blinded by cocoons of ego to what even the ward secretaries could see - their utter lack of clinical skill.
Clinical excellence counts for almost nothing in the academic world. My promotions had nothing to do with my clinical skills - everything to do NIH grants, publications, research and smooze. For all but rare disease or the need for bone marrow or solid organ transplants or certain rare complex surgeries - academic medicine is the LAST place you want to receive your acute care - especially if you are very ill. ICU care demands excellence in clinical medicine from its ICU doctors - not titles, egos, and useless pedigrees.
Just by proposing this, this man reveals his simplistic, two-dimensional, hierarchical, magical thinking - and the reason he saw to it that he himself became an academic. It's how he defines himself. Narcissistic, insecure and lethal.
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