Friday, January 9, 2009

Personalized Medicine at Harvard? Dr. LeWine recommends skipping the DNA..

I was reading this interesting post from Dr. LeWine at Harvard

Howard LeWine, M.D., is a hospitalist at Brigham and Women's Hospital in Boston, where he practices and teaches Internal Medicine. He is the Chief Medical Editor of Internet Publishing at Harvard Health Publications.

He says "Personalized medicine" sounds great. It reminds me of how we embraced the term "holistic medicine" in the past. In fact, personalized medicine and holistic medicine both embrace similar ideals―they provide advice and care based on what is medically best for each person."

That's why I call it Patient Centered Genomic Healthcare, we aim for Personal, we should really strive for patient-centered.

"The goal of personalized medicine, on the other hand, is to offer the patient and his or her doctor the tools needed to accomplish the desired outcome with minimal side effects. This means medical care needs to consist of an approach that the person feels good about, is engaged in, and is likely to follow."

I agree and I think he is hitting a point here....

Genome Scans, Genetic Testing, Family History......these are all tools to be mastered and implemented on a routine basis.....

But he then gets to the real heart of the problem, how do you keep the information in the hands of the patient?

"Personalized medicine can best be accomplished with advances in technology, such as electronic medical records that are formatted to be easily transferred between doctors, hospitals, and other health care providers. Yet, physician adoption of even this most basic technology has been really slow. Small private practices often can’t afford to implement an entirely new system of record keeping, especially when the direct benefits to the practice are somewhat intangible."

An EMR can costs 20-100,000 USD for a provider to implement. Given current reimbursement, he is right. This is a cost most physicians can't afford. Just like taking time out of your schedule to take a detailed family history and give genetic counseling for 30 minutes to an hour. Insurance code for 30 minutes of counseling pays 30-60 USD. Is that really what it is worth?

If we can't get our priorities straight, pay helathcare professionals what they are worth and GIVE Electronic Medical records to ALL providers, we may very well fail at implementation of Patient Centered Genomic Healthcare on a national scale.

Sure we have these things at Helix Health of Connecticut, but I doubt they do in my hometown of Ulster Pennsylvania!

Even with these shortcomings, Doctor LeWine suggests you as a patient take charge.

"What you can do to get personalized medical treatment
Even with the limits that I describe, you and your doctor can very much personalize your medical care. Organizing your medical information is really the first step toward personalized medicine. An increasingly popular way to have your medical information in one place is to create a Personal Health Record. Google, Microsoft, and several insurance companies offer this service for free. This is your record and cannot be viewed by anyone without your consent. You decide who has access to your medical information."

I am not so sure about dumping data into Google or Microsoft. But you could buy your own PHR. Or you could use your insurers. I just am not keen on giving this data to a company who may not have your best interests in holding your data.

Dr. LeWine suggests options for that as well...

"Even if you stay low tech, you can help your doctor provide you with ways to help personalize your treatment:

  • Collect information at home that gives your doctor the most complete picture of your condition. For example, if you have new symptoms, keep a diary for a few days or weeks that indicates when the symptoms occur, how long they last, and anything you were doing before the symptoms started.

  • Ask your doctor what are the specific goals that he or she would ideally like you to achieve. For example, if you have high blood pressure and you monitor your blood pressure at home, what average blood pressure is optimal for you?

  • Ask your doctor for an action plan. For example, what blood pressure readings (high and low) should prompt a call to the doctor’s office?

  • Review your medications with your doctor at each visit, especially if you notice any side effects.

He Misses One Key Point. Take your Family's History. Keep it in a safe place and update it regularly

This is a spot on prescription for starting to begin to achieve patient centeredness, which is the first step in living a healthy life in the 21st Century.

The Sherpa Says: These steps are akin to doing an equipment check PRIOR to ascending the mountain! Don't forget your crampons!!!


RWW said...

From Ulster, PA?? Isn't that where Bishop's restaurant is located? What are you doing at Yale?

Steve Murphy MD said...

Well, I'll Be! You have to love the biscuits and gravy at Bishop's. I usually get a cheesburger and the salad bar though.....

Wha? An Ulster boy can't go up to Yale????