Critical Care Medicine – Not Just a Profession, but a Passion, a Commitment!!

Critical care medicine is a highly challenging and mind-provoking field and it is our proud privilege to be intensivists.

Being an intensivist is a dream come true for us. Only the doctors who are prophetic in their vision, prompt in their thought, and swift in their actions are entitled to choose this profession. For a long time being masked by the other primary specialties, critical care medicine gained its long-awaited recognition in the last 2 years with the COVID-19 pandemic, when intensivists all over the globe led from the forefront, managing the dreaded disease.

The field of critical care medicine started only in the 1950s, when Bjorn Ibsen started the first intensive care unit (ICU) in 1953 during the polio epidemic,[1] and the first-ever known use of the word “intensivist” dates back to almost seven decades in 1965. However, it took another pandemic to bring new recognition to this specialty, and to the intensivists, and officially the word “intensivist” was added to the Merriam-Webster dictionary just 2 years back on April 29, 2020.[2]

During medical school, most of us might have been the last ones to know about critical care medicine as a super-specialty or as a career option. Till the end of the 20^th century, the medical schools had almost no idea of an ICU. Ventilators were considered some machines which never fascinated us and we often looked upon them as a point of no return. Even in the current times, ICU is usually not a place medical students often visit during their ward rounds or ever spend time there.

However, the times are fast changing especially the medicine, and more so the critical care medicine! With a better understanding of the pathophysiology of most life-threatening diseases, and with the advances in technology over the last decade, our outlook to the subject has changed. With the branch coming into the limelight with the COVID-19 pandemic, the perspective of ICUs and the prospects of the intensivists have evolved. Intensivists are racing against time to save more lives. Most of the hospitals now demand fully dedicated and trained intensivists for the successful running of the ICU. The involvement of full-timer critical care physicians not only improves the patient survival but also accounts for the smooth running of the units with lesser infection rates, more successful antibiotic stewardship programs, fewer ventilator days, and reduced length of ICU stay. The National Medical Commission (NMC) now mandates the establishment of a critical care medicine department in all medical colleges,[3] further increasing the avenues for training and research, which will lead to more professional opportunities for young critical care physicians.

A critically ill patient represents a dynamic, continually changing paradigm demanding constant human eye vigil, machine monitoring, and timely swift intervention. The intensivists not only save lives but also improve the quality of the saved lives. They are a group of highly-skilled, expert workforce, trained to cope with life-threatening conditions, producing results at times of pressure. Critical care medicine is an all-encompassing super-specialty, which brings along a lot of responsibility, to be followed with compassion, but eventually rewarding when we see a ventilated patient walking back home. It’s an arena of the medical field where knowledge, skill, experience, humility, attitude, open-mindedness, clear communication, a high level of mental alertness, and quick performance is required at all times.

Most critical care physicians work in hospital-based settings, usually as full-timers in ICU. Mostly they lead the multidisciplinary team and often act as a buffer trying to create cohesiveness among the treating team doctors. They believe in diversity, collaboration, and removing barriers to communication-all to create an environment where teamwork and innovation can flourish. The effective team dynamics, cohesiveness, commitment, and communication skills of the intensivist all affect patient safety and the outcomes. Intensivists are the most dynamic group of professionals-being multitaskers-delivering excellence in infusion therapy, respiratory therapy, hemodynamics, skillful procedures, technology, and ethical and social issues.

The branch of critical care medicine is now recognized as a 3-year super-specialty DM course by the NMC and Doctorate of National Board by the Diplomate of National Board.[3,4] Indian Society of Critical Care Medicine (ISCCM), since its inception in 1993, has made a huge difference to the specialty by establishing the protocols for the smooth functioning of the Indian ICUs as well as building up strong critical care professionals. Various critical care courses started by the Indian College of Critical Care Medicine (ICCCM) under the aegis of ISCCM including the Indian Diploma and Fellowship in Critical Care Medicine (IDCCM, IFCCM) have resulted in ICUs across tier 1 and tier 2 Indian cities being managed by trained critical care specialists.[5] The trainings can be pursued as 2-year courses each (CTCCM and later IDCCM) immediately after MBBS or 1 + 1 year courses of IDCCM + IFCCM after postgraduation in anesthesia, medicine, pulmonology, or general surgery. This year ISCCM has opened its doors to overseas candidates wherein medical professionals from other countries can get trained by the ICCCM. Options for the international critical care fellowships including online European Diploma in Intensive Care and in-training Australian and Canadian fellowships etc., are also widely available for critical care specialization.

Critical care medicine is frequently recognized as an opportunity for anesthesia trainees who wish to lead from the front and not just be acting “experts behind the screen.” With high-end equipment that catches the eye of a younger generation, it’s surely a branch to be followed by the daring people who usually have adrenaline super infused in their circulation. However, seemingly fascinating with new gadgets and fast advances, it’s an arduous and demanding field of medicine, requiring a 24 × 7 commitment, right from the time patient is wheeled into the ICU, till he/she moves out of the ICU. The need to spend long working hours in an all-time stressful environment, high-pressure decision-making, many times leads to burnout and work-life imbalance, thereby questioning the long-term sustainability of the critical care physicians. Furthermore, though critical care medicine has grown as a super-specialty and made its mark among the medical fraternity, the acknowledgment of an intensivist among the general public may still take some time. The major reason behind delayed recognition is a delay in the accreditation by the MCI for super-specialty DM Courses, which have just recently been started in a couple of institutions across the country.

Critical care medicine is no doubt a tough career choice, both mentally and physically, and the nature of the job is likely to get more taxing in the current economic and political scenario of medicolegal issues, but it’s more of a passion! A commitment! The decision to choose a career in critical care medicine is surely not a simple one.

Nonetheless, whether you’re just starting your career, or you have several years of experience, working in ICU each day gives you a unique opportunity to work in a fun, fast-paced, inspiring, exciting, and collaborative environment, where everything you do surely makes a difference-a difference to the patient outcome! A difference to the patient’s family! And a difference to oneself too, where u have a sense of accomplishment!

We are the professionals, who share a love for hard work, a passion for saving lives, and have a vision for innovation. It’s who we are-the Proud Critical Care Physicians!!