TO THE EDITOR:
The article by Gilligan and Raffin [1] and the essay by Hansot [2] highlight a troubling but unfortunately too-frequent occurrence in hospitals today. Gilligan and Raffin express the politically correct position that the physicians caring for Ms. Hansot were motivated by their "preoccupation with the preservation of life." References to the intensive care unit as a place where the patient may be intubated and sedated and "in which the physician-patient relationship may be reduced to a daily 2-minute physical examination" do not support this viewpoint. Rounds this brief cannot represent a desire to preserve life but rather a desire to show up to get a signature on a chart.
Care in the intensive care unit requires continuous monitoring, continuous nursing, and continuous doctoring; the latter is extremely time consuming, even in its most basic form [3]. Most of the difficulties experienced by the Hansots and Ms. Hansot's physicians would not have occurred had a physician been present in that critical care unit.
As do most other physicians, I begin my bedside visit by asking "How are you?", regardless of where in the hospital the patient resides. If he or she is unable to answer, the critical care nurse can, in addition to providing other necessary information. The patient is then examined, and laboratory data, radiographs, and the other "numbers" are reviewed. All of this mandates that time be spent near the patient. Two minutes is hardly time enough to observe a patient from the doorway.
Our role as caregiver is not different from that of our predecessors-to comfort patients, be they healing or dying. This is predicated on serving the wishes of each patient as an individual: for some, curative intent; for others, the alleviation of suffering. The time spent in the intensive care unit attending to the constantly changing status of our patients provides us the opportunity to converse with them and their loved ones so that we understand their fears, wants, and needs.
Perhaps if we viewed the dynamic in its proper context as a patientphysician relationship we would remember whom we serve. The ailing are the masters and we, their servants.
1. Gilligan T, Raffin TA. Whose death is it, anyway? Ann Intern Med. 1996; 125:137-41.
2. Hansot E. A letter from a patient's daughter. Ann Intern Med. 1996; 125:149-51.
3. Weil MH, Shoemaker WC, Rackow EC. Competent and continuing care of the critically ill. Crit Care Med. 1988; 16:298.