Sharing the helm: medical co‐management for the older surgical patient

The management of frail older patients with multiple comorbidities requires considerable medical expertise. While all surgeons are doctors, the rapid expansion of evidence relating to best treatment means that no medical practitioner can expect to be expert in all aspects of patient care. Greater scrutiny of surgical outcomes through initiatives such as the Australian and New Zealand Audit of Surgical Mortality1 and the Australian and New Zealand Emergency Laparotomy Quality Improvement quality initiative2 has reframed the concept of quality surgical care from the outcome of the procedure alone to encompass the whole patient journey and highlighted the importance of older age, frailty and comorbidity in determining outcomes. Multidisciplinary consultation and decision‐making around optimal management depends upon collaboration between different specialties. The Royal Australasian College of Surgeons competency framework recognizes the importance of non‐technical skills required of today's surgeon in providing patient‐centred care.3, 4 This article discusses medical expertise and collaboration as applied to the management of older surgical patients and provides a practical example of a service, which strives to meet this challenge, but the authors recognize there is considerable overlap with the other competencies, particularly ‘communication’, ‘management and leadership’, ‘decision‐making’ and ‘professionalism’.