This may be the longest I have ever gone between posts. As all bloggers do, I will tell you the reason.
I was preparing for my invited lecture at HRS 2013. It was a Hyde Park Talk. This means you stand in one of the busiest parts of the convention, and just start talking. You have a mic and the more you talk, the more people gather around. It’s different.
My topic was ICDs, goals of care and end-of-life conversations.
The names on that list are the biggest in the field. These talks are usually (and after mine will probably revert back to being) given by distinguished professors. So why would a non-academic like me get a spot on that podium? I’m not sure exactly, but here is what I surmise: Dr. Rich Fogel, the HRS program director, called me up months ago and said he read one of my posts on theHeart.org about ICD decision making. He wanted someone to speak about the state of the quality of the decision to implant an ICD. He knew the evidence base surrounding doctor-patient communication on sudden death prevention and ICD therapy was bleak. I can’t remember his words exactly, but it was something like, “this stuff needs to be said.”
When I agreed, I had no idea how hard it was going to be to understand a topic so well that you can talk, off the cuff, without PowerPoint, and to your peers.. First, you had the mountains of clinical data in support of the ICD that needed to be critically appraised. Then you had the matter of risk stratification–or said another way: the fact more than 80% of the time we implant an ICD, the patient gets no benefit. Next, was the evidence base on the decision making. Surveys of doctors’ and patients’ perceptions paint a bleak picture. I kept looking for one study that said we did a good job; I found none.
I interviewed experts all over the country. Many of the most published doctors on these topics were generous with their time. That was cool. They helped me find areas of improvement. For instance, at the time of ICD replacement surgery, and the decision to use a CRT-Pacemaker rather than a CRT-Defibrillator, and also, a focus on the ethics and legality of ICD deactivation at end-of-life.
The talk went well. A good crowd showed. I liked the fact a prominent thought leader (who will remain nameless) came up after and berated me for giving a slanted view of the data and being totally wrong about the fact that deactivation of devices at end-of–life was NOT physician-assisted suicide. He felt it was–and our discussion was spirited. I liked that. Of course, I was surrounded by folks, who by their attendance at such a talk, supported my view.
Two people mentioned to me that is was telling that such a talk was given in this format–out in the convention hallway, with no CME. That’s a topic for a blog in the future.
I expect a transcript to come up soon over at theHeart.org.
Today, I will be presenting in a session on Social Media for the Physician with friends Wes Fisher, Jay Schloss and internet lawyer Bob Coffield.