The Zentensivist Manifesto. Defining the Art of Critical Care

Abstract

Evidence-based medicine asks us to integrate the best available evidence with clinical experience and patient values. In the modern intensive care unit, the primary focus is on complex technology and electronic health records, often away from the bedside. Excess interventionism is the norm. The term “intensivist” itself implies an intensive management strategy, which can lead us away from a patient-centered practice and toward iatrogenic harm. Under the hashtag #zentensivist, an international, multiprofessional group of clinicians has begun to discuss via Twitter how to apply key principles of history taking, physical examination, physiology, pharmacology, and clinical research in a competent, compassionate, and minimalist fashion. The term “zentensivist” intentionally combines concepts seemingly at odds—Zen philosophy and intensive care—to describe a holistic approach to the art of caring for the critically ill. We describe the key tenets of zentensivist practice and how we may inspire these actions in those we lead and educate.

Military Soft Skills Applicable to the ICU

“…Battlefield medicine and CCM both require "trusting our gut. " In fact, normalizing uncertainty, in order to become comfortable with the unknown, and learning to tolerate risk are central tenets of the newly proposed critical care philosophy called, "zentesivism" (7).…”

“…Practicing medicine in austere-environments teaches us to be comfortable with limited data, erroneous information, evolving diagnoses, and providing care without black-and-white answers ( 6 ). Battlefield medicine and CCM both require “trusting our gut.” In fact, normalizing uncertainty, in order to become comfortable with the unknown, and learning to tolerate risk are central tenets of the newly proposed critical care philosophy called, “zentesivism” ( 7 ).…”

Purposeful Inaction in COVID-19. A Medical Student Perspective

“…For example, a patient who receives unwarranted antibiotics for a viral respiratory infection and then develops Clostridium difficile colitis experiences harm because of action. Additionally, “zentensivist” practice calls for a “less is more” approach to intensive care medicine ( 8 ). At the end of life, “do not resuscitate” orders that actively prevent cardiopulmonary resuscitation result in goal-concordant medical care.…”

Can less be more in critical asthma in children?

“…Recently, there has been a concerted movement to more cautiously consider therapies that have no proven benefit, and to attempt to provide less therapy when possible 7 . This more conservative approach involves tolerating some degree of pathophysiology and adaptive responses while avoiding an interventionalist approach to restore normalcy for normalcy's sake 7 . We tend to overestimate the positive effects of our therapies and underestimate the negative effects.…”

“…7 This more conservative approach involves tolerating some degree of pathophysiology and adaptive responses while avoiding an interventionalist approach to restore normalcy for normalcy's sake. 7 We tend to overestimate the positive effects of our therapies and underestimate the negative effects. Just a decade ago, PICUs were filled with intubated children with bronchiolitis for weeks on end.…”