The Art of Medicine Near the End of Life

Care for patients at the end of life has long troubled American medicine, not only in its failure to provide good palliative care, but also in the relationship between doctors and patients. Many efforts to remedy this situation have emerged: a growing and strengthening palliative care movement, better understanding of the situation of patients at the end of life, a sharper focus on the values and behavior of physicians in their care of the dying, and a more general effort to gain medical recognition that end-of-life care is just as important as care during all other phases of life.

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Great progress has been made, but there is still a distance to go. As the number and percentage of people who die from chronic and degenerative diseases increase, the physician skills and virtues necessary to provide good end-of-life care also increase.

The aim of The Hastings Center Cunniff-Dixon Physician Awards is to foster those skills and virtues by providing financial prizes to those physicians, young and old, who have shown their care of patients to be exemplary, a model of good medicine for other physicians, and a great benefit in advancing the centrality of end-of-life care as a basic part of the doctor-patient relationship.

This year there are five prizes totaling $95,000; one prize of $25,000 for a senior physician; one prize of $25,000 for a mid-career physician and three prizes of $15,00 for early-career physicians.

Nominations will be accepted through September 30, 2010.

Surgical Palliative Care:  A Residents Guide.

Surgeons will encounter many patients with progressive, incurable, and terminal illnesses in their role as primary physician 
or as a consultant. This manual has been written specifically for surgeons-in-training, regardless of their future sub-specialty 
career choices, to offer guidance for management of the salient problems encountered in palliative care, including advice 
on self-preparation and self-care necessary to execute these tasks competently while minimizing the risk of burn-out.

This book is a revision of Palliative Care: A Resource Guide for Physician Education,4th Edition by David E. Weissman, MD,  
Bruce Ambuel, PhD, and James Hallenbeck, MD (2007). This curriculum has been used extensively for palliative care 
education in more than 400 residency programs, including general surgery, internal medicine, family practice and neurology. 
This current version has been revised specifically to meet the needs of residents in postgraduate surgical training. The selection 
of topics was based upon the experience of the authors in designing educational programs for medical students, postgraduate 
trainees and surgeons-in-practice. The book is not meant to be a comprehensive collection of palliative care teaching resources, 
rather, to highlight the topics of greatest educational need, as identified by surgical educators and surgical trainees.

Thomas R. Russell, Executive Director of the American College of Surgeons, pointed out in an editorial that the culture of 
surgery is changing, evolving along with long held values. He notes, “No longer is it “my” patient, but it is “our” patient.” 
This shared responsibility for the surgical patient is not without peril, though this ethic has a very positive application in 
the interdisciplinary model of palliative care. Although the focus of his remarks was directed at fundamental changes in 
residency training, his comments apply equally to the norms of surgical practice, especially palliative care: “We can start 
by building a sense of mutual respect for the broad range of individuals [including the patient and his family] involved in 
the care of our surgical patients, from nurses to allied health care professionals, from anesthesiologists to environmental 
service workers. As surgeons we must improve our communication and leadership skills, so these individuals will view us 
in a more positive light.” Surgical palliative care is an approach to patient care that can help us meet this challenge.

—Geoffrey P. Dunn, MD, FACS
—David E. Weissman, MD, FACP