Intensive care medicine: a multidisciplinary approach!


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Intensive care medicine (ICM) is unique in that it deals with the most severely ill patients in almost all fields of medicine. It is demanding in all aspects from a theoretical, practical, co-operational and personal perspective. It is also characterised by a rapid development in diagnostic and treatment options. Furthermore, the organisational and manpower characteristics of European healthcare have been changing over time. Hence, the official status of ICM warrants unbiased consideration.One option to improve the visibility and attractiveness of ICM might be to aim to install a new primary speciality of ICM in Europe. Such a development may lead to more competent doctors in the ICUs and improve the status of ICM within the healthcare system.Presently, the European Directive on recognition of professional qualifications (Directive 2005/36/EC of the European Parliament) does not identify ICM as a primary medical speciality.1 The European Union requires that, to become a primary speciality, it must be recognised in at least two fifths of the member states and, at the same time, by a particular majority (a weighted vote that is determined by the population of each country and other factors and giving what is called a ‘qualified majority’) in a committee on qualification of the European Commission (not only for medical professions but generally for all protected professions). In addition, to create a specialist section for ICM within the European Union of Medical Specialists (UEMS), ICM has to be recognised as an independent speciality by more than one third of the European Union member states and must be registered in the official journal of the European Commission (Medical Directives).Currently, ICM is an independent speciality only in Spain (member of the European Union) and in Switzerland (member of the European economic area). In 10 countries of the European Union (Table 1), ICM can be practised as a ‘particular qualification’ with a common training programme for specialists with board certification in a variety of base disciplines (anaesthesiology, cardiac surgery, cardiology, internal medicine, neurology, neurosurgery, paediatrics, respiratory medicine and surgery). A ‘particular qualification’ is an area of expertise in addition to a primary speciality qualification in which extra expertise outside the domain of the primary speciality is required to provide high-quality patient care.In the remaining 17 countries of the European Union and the remaining two countries of the economic area, ICM is part of the training programme of anaesthesiology (among others) with different lengths of training varying from 6 to 24 months. However, the training programme for anaesthesiology also ranges from 36 to 72 months in these countries.As the requirements for a primary speciality are not fulfilled for ICM, this would be a cumbersome way, but worth the effort if it is considered beneficial to acquire this status. A better way forward is to incorporate ICM as a ‘particular qualification’ in the revision of the European Directive 2005/36/EC in the year 2012.In a meeting of the Multidisciplinary Joint Committee of Intensive Care Medicine of the UEMS (MJCICM) in April 2008, the nine medical disciplines involved in ICM voted against the idea that ICM should become an independent primary speciality. On 19 April 2008, this proposal was supported by an overwhelming majority of the members of the Council of the UEMS.The reasons are rational and obvious. Most importantly, ICM is considered to be too complex to be covered by one medical speciality alone.

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