Table 4 Identity roles of intensivists in decisions of admission to intensive care

Decisions

Gatekeeper

Unfortunately, ICU admission decisions always have serious consequences: it’s important to provide benefit to the patient, avoid harming the patient, and it must also be a just decision for society. (ICU 12)

Life and death decision-maker

We are more or less capable of making life or death decisions quickly. If we choose [Intensive Care], it’s because we can tolerate it [to make life-death decisions quickly]. We’ve been selected. It’s a Darwinian selection. Those that can’t tolerate it go elsewhere. (ICU 05)

The ICU doctor is like an angel of death [...] [who makes] life and death decisions...that is, to stop treatment or not, to consider resuscitation or not. (ICU 06)

Leader

Often, we sort out the emergencies or the degree of seriousness or worry regarding the patient, and we do it often for our colleagues. It’s part of our job, it’s normal. [...] When we’re called to make such decisions, they usually listen to us and it’s rare really to encounter any opposition. We are often the decision leaders (ICU 03)

Support

Consultant

We’re not going to take their place, we indicate the options to explore, and then possibly afterwards the doctor calls us back [...] because the therapeutic alliance is with the ward doctor. We intervene only as a consultant. (ICU 11)

Senior

Our role is obviously to be there for the patient, but also maybe to train our colleagues, especially young colleagues working in the emergency department. That’s part of our role, really…we need to be attentive to their panic or worry. If we show up and say “no, it’s not serious” at least the resident is reassured and we won’t have come for nothing because they’ll be able to calmly take care of their other patients. (ICU 03)

Helper

We’re really, in my opinion, one of the services that helps the most, as often as possible, those colleagues struggling with patients who are on the knife’s edge. (ICU 01)