Australia: Where are we going?

In 2011 Australian intensive care is evolving from the closed shop of a small and dedicated specialty to a much more diffuse form of practice, with many new stresses as the expectations of referring doctors change, the expectations of the general community become at times unrealistic, as well as changes in practice forced by the different expectations of a new generation of doctors. The bureaucratization of health care and growth of managerialism adds a greater burden. The scientific background of intensive care is developing and there is both the privilege and challenge of conducting good quality research in this difficult patient population, as old-fashioned approaches such as it works for me or in desperate times do desperate things are no longer considered appropriate.