Educating surgeons for the new golden hours: Honing the skills of palliative care

Oh life! Surgeons excel at life-saving resuscitations and procedures, forging ahead to beat the clock in the "golden hour." Now these stalwart gladiators must hone their skills to adapt to a different golden arena, the last ticking months, days, hours, and moments of life. Palliative care is an expanding focus for the medical community, in general, and the surgical community, in particular. For many surgeons, this is an unfamiliar concept and a huge paradigm shift, a contrast from what they believe they were or are trained to do. Historically, the surgical perspective has been one of active, aggressive care, with the surgeon dictating the course of care to the patient. Today, surgeons must look at the other side of the same coin, and flip their perspective to the one of the patient and their needs and goals. When weighing clinical options, surgeons must consider the possibility of minimally invasive interventional radiologic or laparoscopic procedures; no intervention versus extensive traditional operations; and perhaps even no fluids or nutrition versus aggressive fluid resuscitation, hyperalimentation, or tube feedings [2]. In an age of outcomes management, new end points must be established for all patients in the continuum of life to death. Surgeons must include a sensitive plan of care for those who have chronic illnesses in long-term care, not only those who are at the end of life or actively dying. The goal must be to maintain quality of life and to relieve suffering, indeed to ''do no harm."