Much of today’s technologies qualify as sophisticated but few truly reach the status of smart. For instance, as our cover story illustrates, cardiovascular implantable electronic devices (CIEDs) provide a life-sustaining function in patients at risk of arrhythmias. But when a patient is near the end of his or her life, these devices also may deliver painful shocks.
For patients and their physicians, the quandary then becomes whether to deactivate the device or have the patient continue to receive its alerts. Here’s the catch: Few patients and physicians broach the topic before this trying period. The technology is sophisticated but can’t anticipate what these patients will want over time. People are responsible for such decision-making.
Improvements in two other disparate technologies—airplanes and the internet—have fueled a different quandary in medicine. Easy access to information in far reaches of the world combined with nearly ubiquitous air travel options allows today’s patients to shop globally for less expensive medical care, especially heart surgery. Are they trading cost for quality? The verdict is still out.
The bigger question may be how to transplant those practices that are less expensive, but have equally good outcomes, into the U.S. healthcare system. See our article on medical tourism for more on the subject.
CIEDs may not be getting brainier but the newest generation may bypass some limitations in traditional devices. For instance, subcutaneous implantable cardioverter-defibrillators (ICDs) may do away with the need to insert transvenous leads in or on the heart. The potential advantages include avoiding implantation complications and, over time, lead failures that may inappropriately shock the patient.
Subcutaneous ICDs are working their way through the FDA process as of press time, although if and when they gain approval is anyone’s guess. One lesson from the CIED end-of-life story is clear, though: Neither they nor the established therapies, no matter how sophisticated, will supplant a mindful healthcare decision-maker.