Intensive Care M e d i c i n e
lntens. Care Med. 5, 99 (1979)
9 by Springer-Verlag 1979
Letters to the Editor
Intensive Care Medicine -- A New Specially? In Portugal multi-disciplinary Intensive Care Units of approximately twenty years' standing exist in the three large hospital centers of Lisabon, Porto and Coimbra. However, specialization in intensive care medicine has not yet been established. In almost all countries Intensive Care Units emerged from individual initiatives, as it did with us. Personnel were recruited from different specialities, with Units progressively becoming independent and autonomous. It is not by accident that during the Second World Congress, where the Sixth Round Table Conference was entitled "Physician education in intensive therapy: from medical student to specialist", the desire to create a World Federation, named '"the World Federation of Intensive Care and Critical Medicine" was expressed. Equally significant is that some o f the National Societies have their own publications and the Journal Intensive Care Medicine has been in existence since 1975. Tinker, in the editorial of issue number 2 - 1976 of this Journal, states that "Intensive Therapy embraces many aspects of respiratory, cardiovascular, renal and metabolic medicine; a comprehensive training scheme will have to cater for all these." We strongly believe that general or multi-disciplinary intensive therapy units must continue to exist and proliferate, and, in the economically stronger countries they have been increasing rapidly in number as was stated in the editorial by Tinker. We, living in a country in development, cannot forget that, these units are the most expensive of all medical services. The most reasonable way to solve this problem in Portugal is to make intensive care as inexpensive as
possible, whilst maintaining its particular characteristics. One of the solutions in our own country is the creation of general units, thus reducing the number of small specialised units. If this is so, we must prepare doctors and nurses to work in these units. Until now they have come from several specialities; but this system does not work. In truth there is no speciality capable, by itself, o f attaining the goals of multi-disciplinary intensive care. We are in the presence of a new speciality. What Doughty states for anaesthetists, and he is one himself, applies to any specialist" . . . an anaesthetist can hardly spend more than a small proportion of his clinical time in the intensive care unit if he is also heavily committed to his primary function of giving anaesthetics."1 Work in a multi-disciplinary unit is too absorbing to allow a parallel specialization, and, on the other hand, the evolution o f knowledge in this discipline is so rapid that intermittent practice of intensive care is not recommended. Above all and what is now becoming an urgent issue in Portugal is the legalization o f this new speciality, and after being established the provision of a post-graduate training programme. It is equally important that a similar programme be started for nurses. It is in this sense that the Portugese Society of Intensive Care has been progressing.
R. B. Carrington da Costa Professor of the Faculty of Medicine of the University of Coimbra Head of the Intensive Care Unit of the Coimbra University Hospital
Tracheostomy and Artificial Ventilation. Ed. by S. Feldman and B. Crawley. Arnold Puplishers 1977 0342-4642/79/0005/0099/$01.00
lntens. Care Med. 5, 99 (1979)
9 by Springer-Verlag 1979
Letters to the Editor
Intensive Care Medicine -- A New Specially? In Portugal multi-disciplinary Intensive Care Units of approximately twenty years' standing exist in the three large hospital centers of Lisabon, Porto and Coimbra. However, specialization in intensive care medicine has not yet been established. In almost all countries Intensive Care Units emerged from individual initiatives, as it did with us. Personnel were recruited from different specialities, with Units progressively becoming independent and autonomous. It is not by accident that during the Second World Congress, where the Sixth Round Table Conference was entitled "Physician education in intensive therapy: from medical student to specialist", the desire to create a World Federation, named '"the World Federation of Intensive Care and Critical Medicine" was expressed. Equally significant is that some o f the National Societies have their own publications and the Journal Intensive Care Medicine has been in existence since 1975. Tinker, in the editorial of issue number 2 - 1976 of this Journal, states that "Intensive Therapy embraces many aspects of respiratory, cardiovascular, renal and metabolic medicine; a comprehensive training scheme will have to cater for all these." We strongly believe that general or multi-disciplinary intensive therapy units must continue to exist and proliferate, and, in the economically stronger countries they have been increasing rapidly in number as was stated in the editorial by Tinker. We, living in a country in development, cannot forget that, these units are the most expensive of all medical services. The most reasonable way to solve this problem in Portugal is to make intensive care as inexpensive as
possible, whilst maintaining its particular characteristics. One of the solutions in our own country is the creation of general units, thus reducing the number of small specialised units. If this is so, we must prepare doctors and nurses to work in these units. Until now they have come from several specialities; but this system does not work. In truth there is no speciality capable, by itself, o f attaining the goals of multi-disciplinary intensive care. We are in the presence of a new speciality. What Doughty states for anaesthetists, and he is one himself, applies to any specialist" . . . an anaesthetist can hardly spend more than a small proportion of his clinical time in the intensive care unit if he is also heavily committed to his primary function of giving anaesthetics."1 Work in a multi-disciplinary unit is too absorbing to allow a parallel specialization, and, on the other hand, the evolution o f knowledge in this discipline is so rapid that intermittent practice of intensive care is not recommended. Above all and what is now becoming an urgent issue in Portugal is the legalization o f this new speciality, and after being established the provision of a post-graduate training programme. It is equally important that a similar programme be started for nurses. It is in this sense that the Portugese Society of Intensive Care has been progressing.
R. B. Carrington da Costa Professor of the Faculty of Medicine of the University of Coimbra Head of the Intensive Care Unit of the Coimbra University Hospital
Tracheostomy and Artificial Ventilation. Ed. by S. Feldman and B. Crawley. Arnold Puplishers 1977 0342-4642/79/0005/0099/$01.00
