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Which is why I tell my interns - what is going to make the most difference is not how diligently you applied the latest EBM, but how you took care of the patient in the context of their beliefs, financial/socio-economic limitations, and how well you equipped them to get the most quality out of the remainder of their life.I didn't meant critical care itself is more complicated by concept. Critical care is all barbaric nuance and backed by little good evidence for doing much of anything. But rather that critical care was complicated by patients with more and more chronic medical illness. You do critical care in the context of more and more other things to take into account. It's not just just sepsis. It's not just sepsis in a diabetic. It's not just sepsis in a diabetic with an EF of 30%. It's not just sepsis in a diabetic with an EF of 30% and COPD. Etc. It's important to take it all into account. And that makes care of the patients more complicated.
Also it is why I think our favorite old timer in the icu says it's unforgivable to let an asthmatic die from mismanagement - it's one of those few things that are 'fixable'