If you were critically ill, which generalist would you want taking care of you?

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NicMouse64

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Title of the thread says it all. Assume you are critically ill but completely undifferentiated. Assuming the doctor taking care of you has not done a ICU fellowship, who would you want? IM? EM? Anesthesiologist? General surgeon? Other specialty I've forgotten?

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Title of the thread says it all. Assume you are critically ill but completely undifferentiated. Assuming the doctor taking care of you has not done a ICU fellowship, who would you want? IM? EM? Anesthesiologist? General surgeon? Other specialty I've forgotten?
I think you’re asking the wrong question. Also keep in mind that the specialty alone doesn’t make the person taking care of you magic. Some surgeons are technicians. Some are amazing well rounded doctors. Anesthesia doctors used to be intensivists by default. Medicine/cc are the ones who really impress me because they use their broad medicine training with higher level critical care abilities to be amazing. So in theory a well trained internist who is used to functioning without consulting specialists and even covers icu patients might be your best bet. Emergency medicine is great to stabilize and line/tube someone but probably not my first pick to do a thorough workup and follow through to get a really sick person better. EM/cc is obviously a great combo that makes the EM doc great to stabilize and beyond.

if you’re goal is to be a generalist at a small hospital then IM might be what you’re looking for. If you’re willing to spend five years in training to become a general surgeon, you can spend five years and do IM/cc or EM/cc or anesthesia/cc and be much more robust.
 
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I think you’re asking the wrong question. Also keep in mind that the specialty alone doesn’t make the person taking care of you magic. Some surgeons are technicians. Some are amazing well rounded doctors. Anesthesia doctors used to be intensivists by default. Medicine/cc are the ones who really impress me because they use their broad medicine training with higher level critical care abilities to be amazing. So in theory a well trained internist who is used to functioning without consulting specialists and even covers icu patients might be your best bet. Emergency medicine is great to stabilize and line/tube someone but probably not my first pick to do a thorough workup and follow through to get a really sick person better. EM/cc is obviously a great combo that makes the EM doc great to stabilize and beyond.

if you’re goal is to be a generalist at a small hospital then IM might be what you’re looking for. If you’re willing to spend five years in training to become a general surgeon, you can spend five years and do IM/cc or EM/cc or anesthesia/cc and be much more robust.
I'm between anesthesia and IM, but leaning heavily towards Anesthesia. What you say about IM is interesting though.

Edit: I'd like to pursue a residency where taking care of critically ill patients is emphasized. For my choice (Im vs. Anesthesia), it seems like Anesthesia places more of a focus on critically ill patients.
 
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Title of the thread says it all. Assume you are critically ill but completely undifferentiated. Assuming the doctor taking care of you has not done a ICU fellowship, who would you want? IM? EM? Anesthesiologist? General surgeon? Other specialty I've forgotten?
I would not want one doctor taking care of me. I would want the EM doctor who likely first sees me to rapidly intubate/perform ACLS if I was in definitive respiratory failure/cardiac arrest and transfer to S/MICU for differentiation/monitoring. The medical system's like an assembly with experts at each stage. To extend my analogy to your situation, it would be like asking one person to run the line on their on.

Also, I'm not sure what critically ill, but completely undifferentiated is. If the patient is acute, why are they acute? Cardiac arrest? Respiratory arrest? All of these things are readily ascertainable and have protocols and don't require a great deal of detective work. Once that's been stabilized the best place for the stabilized critically ill patient is the ICU whether that be the medical, cardiac, or surgical unit depending on the etiology of the incident.

I suppose if you're saying a patient who comes in the door with no history or data to him/her, the ED is the best place to be but that's not because of just the EM physician's training, but the nurses, RTs, etc. etc. as well and their collective experience.
 
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I'm between anesthesia and IM, but leaning heavily towards Anesthesia. What you say about IM is interesting though.

Edit: I'd like to pursue a residency where taking care of critically ill patients is emphasized. For my choice (Im vs. Anesthesia), it seems like Anesthesia places more of a focus on critically ill patients.
I don't have too much experience from an anesthesiology perspective not having done an resident-level rotation with them but many specialties see critically ill patients. It's much more about what you want to be able to do for them. Do you want to be able to control their physiology in the OR? Do you want to be the person who perhaps removes the underlying problem by Surgery? Do you want to figure out the underlying reason behind their shock after they've received resuscitative measures? By definition anesthesia is a more acute field as you're literally sedating people so if that's what you want, then that's Anesthesia.

Also in terms of these combined fields, I would not recommend them for most. As a medical student they seem appealing because of the versatility, but most really want to settle into a niche and get good at doing that niche and move on with their lives. With EM/IM as an example you're definitely more qualified than either an IM or EM physician alone to handle a critically ill patients through their continuum of care after 5 years of training, but you should have a very good idea of what you are going to do with that background because many unfortunately end up practicing one. Not saying there aren't niches available as I imagine they would be great policy-makers with their vantage point at academic centers and perhaps there's a niche in underresourced hospitals. I just think you should have that determined before diving into the training.
 
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Title of the thread says it all. Assume you are critically ill but completely undifferentiated. Assuming the doctor taking care of you has not done a ICU fellowship, who would you want? IM? EM? Anesthesiologist? General surgeon? Other specialty I've forgotten?
Sounds like a great interview question!
 
I'm between anesthesia and IM, but leaning heavily towards Anesthesia. What you say about IM is interesting though.

Edit: I'd like to pursue a residency where taking care of critically ill patients is emphasized. For my choice (Im vs. Anesthesia), it seems like Anesthesia places more of a focus on critically ill patients.
Anesthesia manages machines and drips in the OR similar to an ICU. However, the focus and physiology/ lack or pathology in OR compared to ICU patients makes the intensified care anesthesia provides very different than ICU care. Most anesthesia/cc docs cover cardiac ICUs because they’re good with hemodynamics and cardiac physiology much more than complex medical differentials and managing a million problems per patient x10-20 patients.

IM residency you learn to juggle lots of problems, home meds, etc on an entire service. your job is to complete work ups and start/adjust management plans over the course of days.

Anesthesia residency after intern year: you’re dealing with one patient at a time and your job is mostly to keep their ABCs ok, not trying to complete a workup and not initiating a plan or following up. Most anesthesia meds are very short acting and once surgery is done, then patient usually goes to some other doctor to manage.

Here’s the catch - you need to find a good IM residency where the residents learn to do all that, rather than just consult a specialist for every medical problem. Seems like most academic IM programs should give you that, but I’m just a simple general surgeon so take my input for what it is.
 
Anesthesia manages machines and drips in the OR similar to an ICU. However, the focus and physiology/ lack or pathology in OR compared to ICU patients makes the intensified care anesthesia provides very different than ICU care. Most anesthesia/cc docs cover cardiac ICUs because they’re good with hemodynamics and cardiac physiology much more than complex medical differentials and managing a million problems per patient x10-20 patients.

IM residency you learn to juggle lots of problems, home meds, etc on an entire service. your job is to complete work ups and start/adjust management plans over the course of days.

Anesthesia residency after intern year: you’re dealing with one patient at a time and your job is mostly to keep their ABCs ok, not trying to complete a workup and not initiating a plan or following up. Most anesthesia meds are very short acting and once surgery is done, then patient usually goes to some other doctor to manage.

Here’s the catch - you need to find a good IM residency where the residents learn to do all that, rather than just consult a specialist for every medical problem. Seems like most academic IM programs should give you that, but I’m just a simple general surgeon so take my input for what it is.
It's good to know, I really like physiology but also enjoyed the variety on IM. Hoping if I go into Anesthesia I don't lose that medical knowledge/background.
 
If I personally were critically ill, statistically speaking it would most likely be due to trauma, so I would say a general surgeon or neurosurgeon. If it has to be "general" then general surgery.

If my parents were critically ill, medicine.

My one remaining grandparent, palliative care.

But I would say that the very act of determining that someone is critically ill usually provides enough information to differentiate between medical and surgical critical illness.
 
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So here is the thing about being in the ICU. Today, this is a very multi-disciplinary field. As an Intensivist, you need to be able to understand and “listen” to the physiology or the deranged physiology of the patient because many time, the patient cannot tell you what is wrong. Along with that, since there are multiple systems involved, it is of utmost importance for the Intensivist to bring in the right consultants for the right reasons. An Intensivist it not going to order dialysis, interpret an echocardiogram, or an EEG. In addition, getting the right tube feed rate to prevent overfeeding, getting the right type of tube feed for the patient, perform chest PT, etc and so they need to be able to manage all the ancillary staff to help with this.

Yes, the Intensivist can put in an HD catheter, perform a Swan, perform a therapeutic bronchoscopy (diagnostic if pulm/cc) but again, with the need to manage multiple patients, knowing who to bring in and what for is important.

If you are interested in CT surgical ICU/Trauma/Neuro ICU then maybe a surgical residency is the way to go.

But to answer the question, you would want an Intensivist that is not too proud to bring in the specialists they need, have the right bedside manner, be compassionate to talk to families about end of life, and know what they do not know.
 
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So here is the thing about being in the ICU. Today, this is a very multi-disciplinary field. As an Intensivist, you need to be able to understand and “listen” to the physiology or the deranged physiology of the patient because many time, the patient cannot tell you what is wrong. Along with that, since there are multiple systems involved, it is of utmost importance for the Intensivist to bring in the right consultants for the right reasons. An Intensivist it not going to order dialysis, interpret an echocardiogram, or an EEG. In addition, getting the right tube feed rate to prevent overfeeding, getting the right type of tube feed for the patient, perform chest PT, etc and so they need to be able to manage all the ancillary staff to help with this.

Yes, the Intensivist can put in an HD catheter, perform a Swan, perform a therapeutic bronchoscopy (diagnostic if pulm/cc) but again, with the need to manage multiple patients, knowing who to bring in and what for is important.

If you are interested in CT surgical ICU/Trauma/Neuro ICU then maybe a surgical residency is the way to go.

But to answer the question, you would want an Intensivist that is not too proud to bring in the specialists they need, have the right bedside manner, be compassionate to talk to families about end of life, and know what they do not know.
nice.
 
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