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Invited Commentary
January 2, 2020

Reimagining Surgical Success—Caring for Those Who Die Despite Our Best Efforts

Author Affiliations
  • 1Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 2Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 3Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
JAMA Surg. Published online January 2, 2020. doi:10.1001/jamasurg.2019.5084

Any definition of health that is not silly must include death. The world of love includes death, suffers it, and triumphs over it. The world of efficiency is defeated by death; at death, all its instruments and procedures stop. The world of love continues, and of this, grief is the proof.

Wendell Berry, 20021

Given the technological utopianism that shapes medical headlines, surgeons (and their patients) might be excused for embracing the fiction that with sufficient National Institutes of Health funding, we might all get out of life alive.2 Yet surgical practice is rooted in the reality that despite our best efforts to preserve function and extend life, death comes to us all. And when it does, patient priorities often shift such that what matters most can only be measured through subjective perceptions of support, communication, and the care of one human being for another. Such patient-reported outcomes have been slow to arrive in surgery, but the growing focus on value-based care will only increase their relevance.

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