Personalized Medicine vs Personalized Care: It’s Not Just About Technology

As in so many arenas today (education, communications), the medical fields are all abuzz with the latest technology. Take Personalized Medicine (PM). Personalized Medicine offers the potential for customized treatment based on a patient’s genomic make-up. For example, given that cancer drugs are effective in only a quarter of patients, and medications for ADHD work well in only 1 in 10 preschoolers (1), PM would dictate a more customized approach to treating individuals with such conditions, based on individual genetic determinants.

Still, although PM has captured the public’s imagination, today it is rarely part of care, and its full use remains a future development. That being the case, rather than focus on the future, I’d like to suggest a more mundane but equally powerful interpretation of “personalized medicine.” Let’s call it “Personalize Your Care.”

In recent blog posts I have touched on the changing landscape of healthcare, and in particular how providers today face increasing pressure to see more patients. In such a climate, how can patients and providers work together to achieve better outcomes? Some old-school solutions deserve reconsideration:

1. CONNECT: Recently my 74-year-oldhands, quadriplegic mother was in the hospital. She had a fever and she was a bit out of it. Falling into a quick assumption about people of her generation, the doctor asked what my mother “used to do.” We quickly corrected him, noting that she actively worked as an art professor. This experience illustrates an all-too-common situation. Although we as care providers should try and connect with the people we care for, it is all too easy to think in terms of us (providers) and them: “the patient,” “the pneumonia in bed 3”, “the less fortunate.” To help providers humanize individual experience, patients can start by correcting knee-jerk assumptions.
2. DO LESS: It’s easy for doctors to do something—prescribe a drug, give a referral, suggest surgery. The patient expects it. The system rewards it via reimbursement. Much harder is to do nothing but talk and offer reassurance. Ironically, in the age of Information, this is exactly what will often fit the bill. The Internet offers a cornucopia of information on potential disease, and increasingly patients come armed with a presumed diagnosis. While unfortunately, there is often no free lunch, and patients may require tests with additional risk, worry and costs, they can be encouraged to partner with the provider. Americans want quick answers and quick fixes, but when possible, both patients and providers should pursue watchful waiting.
3. TAKE LESS: (See #2.) Patients should be honest about what medications they are actually taking and take them as prescribed. But if more than five daily medications are prescribed, many patients can’t keep up with the regimented schedule or cost. And frankly, often physicians don’t have a complete list of a patient’s medications, opening up possible drug-drug complications. Patients should always ask if the new prescription is necessary and when the prescription will end.
4. CONSIDER A DIARY OR PERSONAL HEALTH RECORD: Although healthcare should have solved the problem of a unified medical record for all Americans long ago, most people have a fragmented history of their care, and almost no record of how they feel or are doing outside of the clinic or hospital. It’s hard to change therapy for pain or other chronic illness when the answer to “How are you?” is either “fine” or “terrible.” A simple pain record showing a continuum from better to worse on the same morning or evening can go a long way to understanding what is working (or not working) in the treatment plan. Ideally, patients would come to their doctor with a record of their drugs, allergies, office visits and hospitalizations. For most of us, including me, this is too much to ask. For the chronically ill, I’ve been advocating for true nurse navigators to manage this process. It would save grief for the patient and money for the system. But until that time arrives, providers and patients should consider a simple journal maintained by the patient.
5. CONSIDER A CONCIERGE: If you or a loved one have a chronic illness requiring frequent access, consider becoming a customer rather than strictly a patient. Most traditional primary physicians have close to 4000 patients in their insurance panel, leaving little room for conversation; one patient leaves, another soon takes his place. Concierge physicians have closer to 400 patients. Further, as a paying customer (typically this runs between $1500-$2000 a year), the patient typically has near immediate access to his doctor. The savings in co-pays (due to less utilization) may in fact offset the annual charge.

We all want to others to take care of us when we are sick. We’d like healthcare to be effortless, transparent, something happening around us. Unfortunately, this has always been an unrealistic expectation. Engaging and partnering with the provider can be as valuable as the latest personalized genomic analysis. Care ultimately comes down to people as much as technology.

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