My ICD presentation to a Hospice and Palliative Care Group

Last night I gave a twenty-minute presentation on ICDs to a group of hospice and palliative care professionals.

It was a real honor to speak to such an enlightened and dedicated group of caregivers. These are people who really get it.

I wasn’t restricted in what to say about ICDs. They kindly gave me plenty of leeway. That’s scary.

These days, the notion of ‘parallax’ keeps popping up in my mind. That is, the idea that a therapy can look so very different depending on the vantage point of the observer. You can bet a hospice doctor sees ICDs differently than does a heart doctor.

That was my approach for the talk. I tried to show how a cardiac device can be beautiful and life-saving, but also, if not applied smartly in a well-educated patient, these imperfect machines may be associated with substantial risk, fear and no benefit. I tried to show how similarly smart people interpret the same randomized controlled NEJM ICD trials differently. Perhaps it’s because they look at these trials through a different viewfinder–their experiences and feelings about death.

The last few slides summarized my top-five take-home messages from the  2010 HRS Consensus Statement on Management of Cardiac Devices in Patients Nearing the End of Life. Hospice folks know these basic tenets of ethics well, but they were eye-openers for an installer and ablator.

Here are my slides: ICD Parallax-2012


5 replies on “My ICD presentation to a Hospice and Palliative Care Group”

I am sure the slides are very interesting. However, they are the computer equivalent of doctor’s handwriting. I.e., I have no way to read them. The Powerpoint reader suggested by Microsoft chokes on the file.

John, Thank you for these valuable, observations.

You wrote: “You can bet a hospice doctor sees ICDs differently than does a heart doctor.”
Yes, and your observations should help both become more aware of the continuum of care.

I think the points on last few slides (HRS Consensus Statement issues) are valuable across all specialties (as well as anyone planning a full life): Dialogue on palliative and hospice care starting before implant and is ongoing; it involves Pt and Family; it is reasonable for a Clinician to involve a colleague in near end—of—life care.

(from one who still believes exercise EKG’s have value; vs. wait & stent)

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