For me, the only discharge summary I write for my patients is known as a CCOD, or Certificate of Cause of Death. Thereafter, I will not be involved in the care of the patient anymore, but sometimes, complex grief which is not very well supported here in this country makes me have continual contract with some of these grieving caregivers.

One of the thing about signing a CCOD is to cancel off a portion that states that no evidence of pacemaker or pacemaker has been removed from the decease body. Previously, pacemaker are chunky bits of boxy device which you can feel under the skin easily with a notable scar where it was first inserted. As technology moves ahead, new procedures and devices such as Intra-cardiac Leadless Pacemaker will be impossible for simple folks like me in the community to handle. There is no scar, cannot be felt externally and virtually impossible to remove at comfort of patient’s home.

Probably, such cases might be referred to the coroners as none of us can remove such pacemaker in the community. Either our skills in the community must be upgraded or the policy must change. To remain as it is now, patients and their families will have to suffer.