Importance of physician-patient communication in cardiovascular care
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1071-3581/$34.00 Copyright Ó 2012 American Society of Nuclear Cardiology. doi:10.1007/s12350-012-9638-2
recipients of ICDs. Most patients (80%) could not recall a discussion with their doctors about peri-procedural or long-term complications. Only 5 of 35 patients recalled any discussion of the chance of inappropriate shocks, while 6 patients gave responses of no or unknown responses. Only 2 patients recalled a pre-implant discussion of possible future depression. Two actors, serving as standardized patient-candidates for ICD implantation gave mock medical histories to cardiologists regarding the need for an ICD when worked up in an outpatient setting. No psychosocial history was obtained in 50% of these interviews; unexplained medical terminology was used by cardiologists in 67%, and the impact of having an ICD on quality-of-life was minimized or not mentioned in 79%. The average time of the physician-patient encounter in these mock interviews was 24 minutes. The principal author of the second study,3 Dr. Paul Hauptman, stated that, ‘‘Failure to fully engage patients in shared decision-making may be widespread.’’ I am sure that if comparable studies were undertaken in patients who undergo other major therapeutic procedures, similar results of suboptimal physician-patient communication about potential psychosocial consequences, late complications, effects on quality of life (e.g., fear of inappropriate shocks), and end-of-life implications (e.g., heart kept beating by a pacemaker, or an ICD rendering multiple shocks when patient is near death) would be found. For patients with advanced chronic disease, physicians are more comfortable discussing the technical aspects of therapeutic interventions, focusing mainly on procedural risk and not going into detail on possible late complications or quality of life issues. In addition, patients who are acutely ill at the time of these pre-procedural discussions often do not recall such conversations with their providers. The two studies described previously imply that the majority of cardiologists did not exhibit comprehensive patient-centered communication. One wonders whether, for some patients for whom an LVAD or ICD was recommended, true shared decision-making occurred, since potential complications, such as inappropriate shocks, depression, and end-of-life implications, were not clearly communicated. Dr. Kirkpatrick, the author of the LVAD study, and Dr. Gary Francis, who was the 1099
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session moderator, advised revisiting end-of-life issues with patients receiving LVADs and ICDs several months after implantation when patients are more stable and have better brain blood flow.1 At this later time, patients may be more able to comprehend what can occur with these implantable devices when death is near and inevitable. After being more educated by their providers about what to expect in the long term with their implanted devices, they might better express their wishes regarding end-of-life care. They need to unders
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