Cardiology and stewardship — New post up at Medscape|Cardiology

One of the definitions of the noun steward is a person whose responsibility it is to take care of something. Wikipedia calls stewardship an “ethic that embodies the responsible planning and management of resources.” These apply well to cardiologists–who use powerful (and expensive) tools in the care of fellow humankind. The internal cardiac defibrillator, or ICD, is one such “big hammer.” The $30,000 device automatically terminates sudden cardiac death via internally delivered 750-volt internal shocks. These shocks usually prevent the patient from dying of that arrhythmia at that moment. The cost of the ICD, however, is not just in dollars. The tradeoff means exposing the ICD patient to harm, such as surgery complications, infection, inappropriate (wide awake) shocks and the worst harm of all: a bad rather than good death. Said another way, when used well the ICD extends life rather than prolongs death. This is where stewardship comes in. Our job as cardiologists is to see the whole person rather than a person with a list of diseases. Too often, a patient with a weak heart (low ejection fraction) is told they “need” an ICD, or…and here is the catch…”they will die.” You can see where I am going because I’ve been there before so many times. First, there’s the issue of using the verb need in the counsel of patients. Gosh, I hate that. Doctors don’t determine whether patients need invasive treatme...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs