Citation

Dicker R, Brohi K. Br. J. Surg. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, John Wiley and Sons)

DOI

10.1093/bjs/znad246

PMID

37548285

Abstract

Surgery was born out of violence and conflict. Today, violence is still on the rise worldwide, fuelled by disparity and inequity1. Surgeons are, and always will be, on the frontline in the management of victims of violence. Yet, putting bodies back together is no longer enough in modern healthcare. Survival to hospital discharge is not enough if the underlying disease leads to later recurrence and death. A patient with vascular disease is treated with best medical therapy to reduce the risk of requiring reconstructive surgery or amputation. A patient who has had vascular intervention is given best medical therapy to reduce the future risk of disease progression. The same is true of violence as any other surgical disease. There is little to celebrate from heroic surgery and survival if the patient returns shot or stabbed a few months later or, even worse, becomes another homicide statistic. Reducing violence and preventing harm is, therefore, a priority for many healthcare systems around the world. Yet, delivering violence risk reduction can seem like an overwhelming proposition in comparison to prescribing statins or referring to smoking reduction clinics.

So why should surgeons be involved in violence reduction at all? The authors believe the answer to this question lies in the ultimate vocation of any surgeon being to 'finish the job'. The job has always been the care of the whole patient. Surgeons' interventions extend beyond the confines of the operating room, from preoperative management and counselling through postoperative care to discharge and community follow-up. Although they need not shoulder the entire burden, surgeons can initiate interventional pathways, call upon colleagues from other specialties, and engage multiprofessional teams. Surgeons must also accept that they have a position in communities. They can use their voice to advocate for their patients and for comprehensive violence reduction programmes for local populations...

Language: en