Shared Decision Making and Mike Wallace

Mike Wallace, the well-known veteran journalist of CBS' 60 Minutes, passed away on Saturday.

Working in journalism for more than 60 years, he died at age 93. He had lived for many years with heart problems. He had had a pacemaker installed more than 20 years ago, and had had triple bypass surgery in early 2008.

Experts are becoming more skeptical about many forms of surgery and screenings, particularly heart surgery. The National Priorities Partnership, for example, has identified coronary artery bypass grafts (CABGs) and percutaneous transluminal coronary angioplasty (PTCA), among others, as often unwarranted, and has recommended that healthcare organizations concentrate on reducing them. Yet Wallace was able to live to a ripe old age with the benefit of several heart operations. It's very complex to ascertain whether an operation is right for a certain person. That's why shared decision-making, perhaps with a patient advocate, is so important.

Shared decision-making will be the subject of a forum in Waltham, Massachusetts on April 10, organized by the Massachusetts Health Data Consortium. Dr. Henriette Coetzer and David Veroff of Health Dialog will make presentations for the session, entitled "For Good Measure: Identifying Opportunities and Outcomes for Patient Decision Quality."

For considerations in the surgery decision, see Chapter 3 of my book, Getting Your Best Health Care: Real-World Stories for Patient Empowerment.

She turned 104 in April: Aggressive treatment for centenarians

Her father had sent her to secretarial school. She married, and then split up with her husband, a traveling salesman, during the Great Depression. She worked as a stenographer to pay rent to her parents for a small sunny bungalow overlooking a canal in East Rockaway, New York. She retired in 1961.

Then in 2003, when Hazel Homer was 99, after several recent hospital stays, more than one doctor advised that there was little to be done about her failing heart except wait for it to fail a final time. But Hazel was not interested in waiting to die of old age.

She kept talking to doctors until one agreed to install a biventricular defibrillator, five years ago. Now, at 104, her heart is still ticking, thanks to the specialized pacemaker and defibrillator that synchronize her heartbeat and can deliver a slight shock to revive her if her heart falters.

So far, it has never needed to shock her heart out of a potentially fatal arrhythmia.

Hazel now has a live-in aide at her tiny bungalow. She has been quite healthy throughout her life. Indeed, since the surgery, she has had only a single hospital stay, a brief one for pneumonia.

Her operation, a month before her 100th birthday, reflects a new frontier in medicine: surgery for centenarians. Some say, however, that aggressive treatment for the extremely elderly can give patients false hope and a diminished quality of life.

Advice to adult children of extremely elderly parents: Heed your parent's preferences about aggressive care, rather than your own.

Read a story about aggressive care on the other side of the coin.

Thanks to Anemona Hartocollis for the source article in today’s New York Times.

He resumed his normal schedule: Vice President Cheney’s defibrillator/pacemaker and side effects

Vice President Dick Cheney, who has a long history of heart disease, had minor surgery on July 28 to replace the implanted heart device that monitors and adjusts his heart rhythm (an “implantable cardioverter-defibrillator”). An annual physical the month before had showed the battery had reached the level at which replacement is recommended.

Mr. Cheney was sedated for the procedure, which was performed Saturday morning. He walked out of the clinic at mid-day, returned home, and “resumed his normal schedule,’ his spokesperson said.

Mr. Cheney has had four attacks, the first at age 37. He has had a quadruple bypass surgery and two angioplasties to clear blockages in the heart arteries.

Men of the age of Pres. Bush and VP Cheney may be too stoic to admit they are experiencing even temporary periods of disability or physical weakness. This stoicism or denial may lead them to make poor decisions. It seems that these men ignored the subtle but powerful temporary after-effects of conscious sedation, when their judgment may well have been impaired, at our peril. In both cases in the last month, their judgment before surgery that they would be just fine, thank you, right afterwards, was also mistakenly self-confident.

Advice for those recovering from same-day surgery: Admit you are not fully yourself and give yourself the day off.

You can read more from the source article in the New York Times of July 29.