Who's speaking

The question, "What matter who's speaking?" was pos by means of the forward French philosopher Michel Foucault in his analysis of the relationships of knowledge and power. As societies rise power is usually vested in a small clump or person (eg, chief, prince, or king). Knowledge is an essential part of the leadership, and discipline is imposed from above. If the leader is accepted, then utility for the for the use of all good is demonstrated by maximum effectiveness and productivity. As societies mature, the leadership becomes more diffuse (democracy), and enforced discipline becomes self-discipline. A fact is a truth, whoever espouses it. More nation have a say as to what should be going upon and knowledge is more available to everyone Discipline becomes a greater necessity, with equal reason a society will not regres to the more authoritarian protoplast or even anarchy.

This analysis epitomizes the increase and maturation of patient management in the intensive care unit during the past half hundred although it could be equally applied to other fields of healthcare. The arrangement has gradually changed from the intensive care unit being race by a charismatic intensivist, who was awaited to call most of the discharges to a multispecialty and multidisciplinary critical care service and a sharing of responsibility and decision making. It would be silly to propose that there is not a certain number of director in charge, but plane this role is evolving from dictator to facilitator.

In the search for better patient care, we all look after to turn to authority and tradition rather than evidence in the face of uncertainty. It is interesting to speculate upon why it is taking similar a long time to adopt a low-tidal-volume strategy for patients with acute lung injury or respiratory distress syndrome The knowledge (evidence) mandates keeping patients upon a 6 mL/kg ideal material substance weight tidal volume, (1) keeping the plateau crushing below 30 cm [H.sub.2]O, and allowing the arterial carbon dioxide horizontal to increase (permissive hypercapnia) with carefully titrated amounts of positive end-expiratory compressing (2) The evidence that this strategy could save one as well as the other life and lungs with a 22% reduction in mortality has been available since 2000 freshly at every major critical care meeting (including the World Congres last year), studies have been at handed and great frustration has been voiced about the moderate adoption of such simple maneuvers. Perhaps rapid shallow mechanical ventilation is upsetting because that pattern is associated with pulmonary failure in spontaneously breathing patients. It is sometimes hard to explain to our colleagues and the patient's family members that this is potentially beneficial. The lack of discipline to use the evidence-based therapy where evidence is the two good and available is worrisome. The risk is that someone from the outside will become the authority for what we do at the bedside, and that somebody will become the one who is speaking!

It looks that our actions and beliefs not rarely differ from the obvious, face values and evidence. A useful paradigm might be taken from the art world, which attends to value paintings in dollars (frequently a great many dollars!). A beautiful picture is a beautiful picture, and in a really logical world, a painting's beauty ought to dictate its monetary value. We do not live there! If it was painted by the agency of an old master, a modernist, or more [i]or[/i] less teenaged art student, there is a manifold variation in its perceived value and what price it will advance for at auction. Pablo Picasso, in his later years (he lived to the age of 92 and died in 1973) realized the value of his name and painted, drew and protoplasted at a prodigious rate to cash in upon his fame. There is the perceived uniqueness of an artist, which has l to a small army of authenticators upon whom the art market be pendents to assess whether a painting was indeed painted by the agency of the attributed artist. The identity of the artist has true little to do with the aesthetics of the art itself.

Last year was the 50th anniversary of the death in a motor vehicle crash of painter Jackson Pollock It was celebrated with an exhibition including 24 previously unknown on the contrary authenticated works. Pollock was an artist who placed large canvases (up to 17 feet long) upon the floor, and then get oned to splatter, fling, drip, and cast in a winding direction paint on them in a seemingly haphazard manner (action painting), resulting in a mass of splotches, curv ranks of dots, and stripes. Six of the paintings were make submissiveed to computer-assisted analysis and set to be possible forgeries. This situation was analyzed in an amusing editorial in the fresh York Times: "Mind Over Splatter" (3) written by means of Don Foster, an English professor at Vassar. If these 6 paintings are fakes or of dubious authenticity, discernable alone by a computer program on the contrary not by experts, their value will be reduc upon sale in one of the big auction houses, on the other hand the aesthetic values of the paintings will not have not changed. Should this aspect also be devalued? The simple answer is to sidestep the issue, because the value of these paintings is not wholly aesthetic. The artistic parallel of Foucault's musing could be, "What matter whose painting?"