What is the direction of Tokyo Bay ICU?

What is the direction of Tokyo Bay ICU?

My name is Norisue, and I am steering the Intensive Care Department at Tokyo Bay Urayasu Ichikawa Medical Center.

As you might imagine, there is a vast amount of knowledge and skills required as an intensivist. For example, differential diagnosis ability, airway management, knowledge of postoperative management for cardiovascular surgery, how to read continuous EEG, ECMO cannulation, communication skills with patients, families, and other departments, and so on. Our department has an environment in place to properly teach and practice these skills. However, why do we acquire this knowledge and these skills in the first place?

That's right. It is to help patients.

Then, what does it mean to help a patient?

I believe that in many facilities, much of the frustration in daily clinical practice stems from a misunderstanding of what it means to "help a patient." In particular, distress arises from the lack of alignment between the "mission" defined based on one's own values as a healthcare professional and what is best for the patient right in front of them. I will explain that now.

Let's consider the reasons why patients and their families call an ambulance or come to the hospital. Of course, "I want to be cured of my illness" or "I want my life saved" are at the center of it. But that is not all. There are also cases like "I want you to do something about this pain" or "My mother is suffering, and I don't know what to do." Many of these patients come to the hospital in the process of their chronic disease progressing and their remaining time running out. What kind of medical treatment should we provide to such patients and their families to "help" them? How can we "help" a patient who, unfortunately, is certainly dying despite maximum treatment due to complications from an elective surgery? Even if the remaining time is short, there may be patients who wish to have their hearts kept beating for even one more minute or second, even if it means being restrained. However, there are also many patients who do not wish for that. To help such patients, it is necessary to provide sufficient palliative care, stop treatments that are causing suffering, and provide the highest quality dying process possible.

In other words, for an intensivist, the knowledge and skills to provide appropriate medical care for life-saving and the knowledge and skills for palliative care are two sides of the same coin. If either is missing, you cannot provide the best treatment for the patient in front of you. At our hospital, a culture and system have been fostered that allow us to understand the patient's values and provide the best treatment for them after performing appropriate, world-standard medical care. Of course, it is not 100% perfect, but when we are unsure of what to do, we always try to think as a medical team, "What is best for this patient?"

"Someone important said this" or "We did it this way at my previous facility" is not important at all.

The only North Star for Tokyo Bay ICU is the patient.