Physician-patient relationship in the intensive care unit: erosion of the sacred trust?

With the advent of the increasing technology and multispecialty medicine, the strong relationship or "sacred trust" between patient and family physician has gradually eroded. Various subspecialists are now entrusted with patient care at different phases of evaluation and treatment. Because of the transient nature of these physician-patient interactions, a strong bond is often not established before critical decisions must be made concerning ongoing patient care. As a result, multiple members of the different healthcare teams (the care cooperative) may be confronted with addressing end-of-life discussions, which in the past was the responsibility of the primary physician. Because of this need to move into a previously viewed private territory, communication conflicts may arise between members of the healthcare team. In an effort to understand and deal with observed recurrent problems that occurred when patient care was transferred between specialty care teams, our institution has addressed communication conflicts that arise in the care of oncology patients transferred to the intensive care unit. Our goal has been to initiate and maintain a dialog to avoid misunderstandings and to reduce anxiety between members of the intensivist and oncology services. To this end, we have addressed the various pitfalls that come with the transition from the traditional physician-patient relationship to the more fluid and comprehensive care-cooperative mode. We believe this approach to be useful in improving communication between healthcare providers in the multispecialty care setting, which will ultimately enhance the quality of patient care.