by distortion to threads 168 or 170 or in any other suitable way referring now to fig3 there is shown a tool 100 for gaining access to and driving screws for pacemakers tool 100 comprises a body 102 including an outer enclosure 104 a proximal end 106 a distal end 108 and an axis of rotation 110 the tool 100 also comprises a screw driving blade 112 projecting from body 102 along axis of rotation 110 from proximal end 106 and a cutting bit 114 supported by body 102 along axis of rotation 110 cutting bit 114 projecting from body 102 from distal end 108 in the implementation of fig3 screw driving blade 112 is fixed to body 102 body 102 is solid screw driving blade 112 and cutting bit 114 embedded within body 102 body 102 includes external splines 128 external splines 128 not only facilitate secure manual grasp of body 102 but also enable tool 100 to cooperate with a torque wrench not shown having a socket cooperating with body 102 this enables an inexpensive version of tool 100 to be realized tool 100 has been described for use in the environment of medical pacemakers only for convenience of understanding in terms of applying tool 100 to an environment having recognizable characteristics it should be realized that tool 100 is not limited to this environment and may be utilized in any environment where it is desired to remove.