We surgeons perform some cures; more often we palliate, leaving unfinished business that then becomes the responsibility of some member of our profession. I propose that the act of fulfilling this responsibility should be undertaken, at least occasionally, in the patient's home and by his surgeon.
Take, for example, the lonely frightened woman with a long-standing ileostomy for ulcerative colitis suffering severe abdominal cramps and having no neighbors, friends, or ready means of transportation; the older patient with recurrent cancer of the pharynx, obviously preterminal, but with an intermittent airway problem; the patient with a large venous stasis ulcer being treated at home on wet dressings and elevation; the hemiplegic with a failed femoropopliteal bypass graft for toe gangrene in his paralytic leg, awaiting decision for or against amputation.
The surgeon is rarely called to the home to see new patients suffering from "primary care" problems. But those whom he