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Pinpointing What is Troubling the

Person Most

Third Revolution in Healthcare

Pinpointing What is Troubling the Person Most – Patient and Clinician sharing ownership

Increased laboratory testing and enhanced imagery led to the second health revolution that greatly improved disease diagnosis. The imaging, of course, was less painful, MRI being better than the most people’s arteriography. Genomic testing has led to the creation of what is known as precision medicine, but the moniker has not always been justified, though it is vital for the distinction of precision medicine from personalized medicines.

According to us, precision medicines are defined as treatments that respond to individual patients by using genetic, biomarker, phenotypic, or psycho-social properties that distinguish a patient from other clinically identical patients. Hence, it aims to improve the therapeutic results for individual patients and minimizes unwanted side effects for individuals who are less likely to respond to a certain therapy.

Source: Jameson JL, Longo DL (2015) Precision Medicine – Personalized, Problematic and Promising.  N Engl J Med 372; 23: 2229.

…”personalized medicine” proposes a treatment method centered on people instead than groups. In describing age, coexisting situations, interests, and beliefs in developing an individual management plan, the phrase has been used to describe the consideration.

Source: Garber AM, Tunis SR (2009) Does Comparative-Effectiveness Research threaten Personalized Medicine? NEJM 360; 19: 1925-1926

While these developments were excellent, several tests have caused the problem as well as the issues of “over-diagnosis.” Problems which were never diagnosed before to the Second Health Revolution can be recognized that are anatomically and physiologically wrong but which lead them to new illnesses such as pre-diabetes. Over-diagnosis is currently a significant concern for all healthcare providers as it leads to treatments that can sometimes cause harm and waste resources. For example, during antenatal screening during pregnancy, various phenomena such as ‘echogenic bowel’ had been detected by the more sensitive ultrasound machines. Hundreds of women with normal fetuses were therefore brought to amniocentesis with a directly connected 1.5% error, but echogenic bowels were simply recognized by the more sensitive tester as normal manifestations and subsequently categorized as disorders.

For instance, an orthopedic surgeon who was a specialist in knee replacement was mentioned to Mrs. P. The specialist asked Mrs. P on how he could help her, to which she answered, “I need a replacement for her knees.” He further replies with a question, “What is it you’re most troubled abour?” To which she said as “oh gardening. I love gardening. I find it hard, bending my knee while doing it” and he answered, “I hope you understand, that, even if the procedure is really effective, if I replace your knee, you may not at all be able to kneel, because those with knee replacements  are too uncomfortable to kneel.” She stood up, said thank you and left the room, maybe to go and buy handled, tools for gardening or to create an elevated flower bed.

She was saved from having a procedure that would not have remedied the problem that was bothering her the most, and the hospital and payer were saved from wasting resources.

Key Points to Consider for the Health Service – Ensure Not Only the Diagnosis but Also the Root Cause That is Troubling the Person Most

It’s also necessary to make sure that the health service does not only ensure that the diagnosis is accurate, but also that the clinicians are sure that they understand what is most disturbing to the individual. This means that the person needs to think about it and express clearly what is most disturbing to him.

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