{"id":8116,"date":"2011-05-09T09:16:13","date_gmt":"2011-05-09T13:16:13","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=8116"},"modified":"2011-07-19T17:45:18","modified_gmt":"2011-07-19T21:45:18","slug":"words-icds-and-patient-centered-medicine","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/05\/09\/words-icds-and-patient-centered-medicine\/","title":{"rendered":"Words, ICDs, and Patient-Centered Medicine\u2026"},"content":{"rendered":"

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog, Dr John M.<\/a><\/em><\/p>\n

Guess what made the heart rhythm newswire yesterday?<\/p>\n

It wasn\u2019t a new medicine,<\/p>\n

or a new stent,<\/p>\n

not even a new ablation catheter,<\/p>\n

and it surely wasn\u2019t a revolution in motivating people to exercise.<\/p>\n

It was words. Rhetoric\u2026 It seems that one man, Dr. John Wilson, read all of the major \ufeff\ufeffimplantable cardioverter defibrillator (ICD) trials, dating back more than a decade, and found that the study authors emphasized positive aspects of ICDs while giving less weight to their sobering complication rates<\/a>.<\/p>\n

As reported by Steve Stiles on \ufeffThe Heart.org<\/a>, Dr Wilson likened such \u201cmessage framing\u201d to marketing strategies that try to sell a product.<\/p>\n

Though his opinions bordered on the sensational, Dr. Wilson’s advice spoke strongly to me, as here:<\/em><\/p>\n

\u201cI think the bulk of the information from these trials would suggest that these devices do make people live longer, but I think it’s also very likely that if patients were given a more balanced view about risks and benefits, fewer of them would be willing to take it on.\u201d<\/em><\/p>\n

And\u00a0here (emphasis mine),<\/p>\n

“Guidelines,”<\/em> he said, \u201ctend to make it sound like if something is found to be effective, it should be put in all patients with that problem, when in fact what should probably be said is: <\/em>if it\u2019s effective, patients should be given information about the benefit and the risk and allowed to use their own judgment to decide <\/span>whether they\u2019d prefer to live a little longer\u2014in many cases just a couple of months longer\u2014or possibly experience infection or get shocked multiple times with the defibrillator.”<\/em> (If patients received this type of information), “you\u2019d probably find that a lot of them would be very skeptical about having these devices put in.\u201d<\/em><\/p>\n

That last paragraph slants a little too far to the negative, but it suffices to show how a patient-centered ICD conversation is a tough one. It also highlights the notion of how practicing medicine gets harder as we accumulate better, and more invasive, tools\u00a0(and provides yet another\u00a0excuse<\/del> reason\u00a0why so many of us fall so woefully behind in the office).<\/p>\n

In selected patients, ICDs unequivocally provide\u00a0benefit. However, as with any invasive treatment,\u00a0there are risks and alternatives, making ICDs\u00a0akin to many other expensive and invasive therapies. Cancer chemotherapies (for example,\u00a0adriamycin with its cardiac toxicity) come to mind.<\/p>\n

Most smart doctors read journal articles with a critical eye. They (should) know that the writers are passionate and convinced of their positive findings. Such is human nature.<\/p>\n

JMM<\/p>\n","protected":false},"excerpt":{"rendered":"

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog, Dr John M. Guess what made the heart rhythm newswire yesterday? It wasn\u2019t a new medicine, or a new stent, not even a new ablation catheter, and it surely wasn\u2019t a revolution in motivating […]<\/p>\n","protected":false},"author":655,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,1,14],"tags":[448],"class_list":["post-8116","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","category-general","category-heart-failure","tag-icds"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8116","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/655"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=8116"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8116\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=8116"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=8116"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=8116"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}