In response to the September editorial, “Conflict Management in the Intensive Care Unit,” I’d like to note that the arguments about conflict between clinical teams do not apply only to the surgical intensive care unit (ICU). Many institutions have an open medical ICU, in which the attending physician of record is a hospitalist or primary care provider and the intensivist is a consultant.

This setup can lead to conflict if the ICU staff’s culture is to contact the consulting intensivist directly about changes to a patient’s condition. This leads to action, without the knowledge or consent of the attending physician of record. This can be especially troublesome if the ICU team invites other consultants into the care of the patient, making it more difficult for the primary team to coordinate all of the care.

The resolution is for the primary and ICU teams to negotiate their roles up front...

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