|
|
Message from the President
Remembering to Care
Mitchell M. Levy, MD, FCCM
Professor of Medicine,
Director Medical ICU
Brown University School of Medicine
Rhode Island Hospital
Providence, Rhode Island, USA
I am excited and honored to be your 2009 Society of Critical Care Medicine (SCCM) president. Throughout the year, I plan to address several topics in Critical Connections, which I hope will be of interest to each of you. I thought it would be appropriate in my first message to start at the beginning. Let’s take a moment to think about where critical care medicine is as a discipline and where we are as individual intensive care unit (ICU) caregivers.
How did we get here? Why did we come to critical care? For many of us, critical care brings a unique opportunity and challenge – our vulnerable patients require a high degree of moment-to-moment attention. The complexity and severity of our patients and the rapidly evolving nature of critical illness require ICU caregivers to bring their knowledge (as well as their interpretation of the current literature) to the bedside. We must integrate that knowledge rapidly into our observation and assessment of a patient and then quickly develop a coherent therapeutic plan based on collaborative decision making. All of this is conducted in a brightly lit environment filled with bells, alarms, buzzers, screams and blaring television sets with more caregivers per square inch than any other hospital setting. Just as powerful as the intellectual and diagnostic demands just described is the equally challenging demand to stop what we are doing at any given moment, shut out the noise, open our hearts and sit with a patient’s family to explain that they may lose this person they love so dearly. Balancing the intellectual demands of critical care and the emotional and spiritual demands of death and grief is what defines us as ICU caregivers. This challenge to balance intellect and compassion in an intense environment is the force that drove many of us into critical care. It is the fuel that allows us to care so deeply about our patients and to view ourselves as fierce patient advocates.
Although this may be where we started, it has become difficult to remember in today’s environment. It is easier to talk about the growing numbers of patients, the shrinking numbers of nurses, physician shortages, long hours, fewer resources from hospital adminstrators, and increasingly unrealistic expectations from families. We are more likely to be distracted by the obstacles than to remember simply to care. Remembering to care seems to have become an everyday challenge in the workplace. To ask ourselves if genuine caregiving has become a luxury would not be unreasonable. In a fast-paced, task- and technology-driven environment, can we find a way to remember simply to care? Certainly, despite the high rate of burnout we see in many of our compatriots, the answer must be “yes.”
Every day in the ICU our colleagues provide examples of this kind of caring – taking the extra time to meet with families, spending the additional few moments to reassure an anxious patient, or refusing to settle for an easy diagnosis and re reviewing laboratory and diagnostic tests. Often, if we forget to care, we quickly are reminded of our lapse by another member of the ICU team. The collaborative environment inherent in the ICU can be a potent force for patient care. In any given ICU, multiple patient advocates represent each aspect of the team. As with any team dynamic, when one member is not performing at his or her best, the possibility exists for someone else to step up and carry the load. This aspect of our ICU world – the collaborative team – might provide the best opportunity to overcome common ICU distractions, causing us to remember to care. We truly are fortunate to share our professional world with colleagues from many disciplines and professions who advocate for the same end – providing the best possible care for critically ill and injured patients.
The growing quantity of details, pieces of physiologic data and diagnostic tests are becoming overwhelming for clinicians to process. We understand from many studies in critical care that the strength and quality of caregiving depends, at least in part, on paying attention to the small details. These details are at the heart of remembering to care. Critical care nurses have used these practices for generations – rubbing patients’ feet with lotion, combing patients’ hair, shaving patients and speaking kindly to patients. To that list we now can add equally obvious details, such as washing hands, ensuring proper sedation, turning patients and monitoring bed position, to name just a few.
In summary, remembering to care is not only possible, but essential for protecting our vulnerable, critically ill and injured patients. We do have the tools and resources we need to remember to care: our dedication and our colleagues. Let’s use them.
As I said in the beginning of this message, I look forward to serving as the SCCM president. I hope to share with you some of the initiatives planned for this year in future Critical Connections columns. Most importantly, I welcome any suggestions or comments about your Society to info@sscm.org.
|
|
|
|
|
| |
|
|
| |
|
|
|
