The power of the specialist physician — and stewardship

My latest column over at theHeart.org discusses the disordered balance of power in the doctor-patient relationship.
As most of you know, I harbor strong biases about the quality of medical decisions, especially in the elderly. Attached. Yes, I am attached to the issue of decision quality. Nearly all of electrophysiology, and much of cardiology, involves preference-sensitive decisions. This means doctors are called to align treatments with the goals of the patient. We hold great power; we must use it justly and wisely.
My latest essay arose from an unusual source. The prominent medical journal Circulation Outcomes publishes a section they call Caregiver Viewpoint. The editors aim to understand patients’ experience of cardiovascular disease. Patients, families or caregivers write articles that explore the effects of treatment–on them. (Remember Dr. Montori’s discussion on the burden of care.)
You can imagine that this exercise–of looking at how patients experience communication, decision making, care coordination, access, cost, timeliness and safety–could get thorny for doctors.
In the latest Caregiver Viewpoint, two physician daughters wrote about their Dad’s experience with an ICD at the end of his life. Their father, a retired psychiatrist, survived a cardiac arrest at age 79. He had an ICD and stent placed at that time. He then did pretty well. The ICD never had to act. He aged. So did his ICD, which developed a lead problem that forced a...

Source: Dr John M - January 30, 2015 Category: Cardiology Authors: Dr John Source Type: blogs