Margaret Heale, RN, MSc, CWOCN
"Personalized medicine" is apparently a new concept that has evolved from taking good family histories, then adding a genetic testing component. The idea is to help assess the risk of specific traits that may be evident, and confirm with genetic testing so people can make lifestyle changes that reduce risk. It has attracted a huge amount of attention over the past few years.
While the concept includes promising approaches to things like cancer treatment, much of the focus has been on using genetic risk information to motivate healthy lifestyles. In his 2015 State of the Union address, President Obama suggested that future advances in biomedicine would provide the "personalized information we need to keep ourselves and our families healthier." Francis Collins, the director of the National Institutes of Health, has suggested that personalized medicine "means taking better care of ourselves" by, dare I say, changing behaviors based on the possible risks we face.
Both describe living healthier lifestyles to prevent chronic disease. The promise of personalized medicine lies in its ability to inspire behavior change. Having this genetic information isn't inherently helpful; it's what people do with the information that matters. Inspiring lifestyle changes sounds easy. It is not. What happened to your New Year's resolution?
I am not sure anyone can tell someone how to inspire others, but I do think I can touch on a few things that are essential while trying to be inspirational in our roles as clinicians. It just so happens that these could also be described as "personalized care."
Personalizing Health Care By Knowing Your Patients
This view of personalized health care begins with a few simple exercises for the clinician—before ever walking through a curtain or the door of a clinic. It makes an enormous difference to people, and they are more likely to feel cared for, adhere to treatment plans, and recover more quickly. It is not easy, apparently, because we do not practice it well—but it is part of what is known as "bedside manner."
- Know the name of your patient and how they prefer to be addressed.
- Knock before you enter.
- Ask them how they are and listen to their reply.
- Know their summary, why you are seeing them, and what their plan of care is.
- Know any significant changes since your last visit/shift.
- Personalize written information as much as possible. Giving a vegetarian a care and information sheet after a colonoscopy that says, "eat less red meat," is not helpful.
If a patient questionnaire is used, look at it! Don't ask the patient the same questions.
How hard is this? When I was a student, it was easy for the doctors because they were always accompanied and given a patient synopsis on the way.
Now, as a consultant, here is what may occur: I say to a nurse outside a patient's room, "does he prefer Christopher or Chris?" She tells me she has just been on vacation, off sick, or on a different team.
So, I go to a computer, switch it on, and remember I changed my password… What was it again, oh no that was the other facility. Find the patient… How do you spell his name? Maybe the room number would work better. I thought I saw him last week. Where is my note? Which side of the buttock is the pressure injury on? Wasn't there another wound too? Oh, I might as well wing it.
So, I go in the room, "Hi Chris, (Oh no, I thought it was a he) I think I saw you last week, didn't I? How is it going? Could you roll onto your left side?"
…Or should it be right? Oh no, it wasn't a buttock wound and he is a she.
"Oh, it was your heel, wasn't it? I remember now, let's have a peek. Oh, I see you ended up with another amputation. How is your pain?"
This may seem extreme but parts of this scenario happen daily.
It is hard to prove that you care after such a bungle, but we do… And we need a little help. Where is Siri when you need it? Such a simple addition—a summary app that answers a few questions to jog your memory or does a synopsis of the patient summary, new labs, your last note on the way to see the patient… How cool would that be? I am very serious, and I know the technology is here.
Patients want us to be personable and remember them. It makes a difference. I know because I have been a patient too, and when the doctor asked me why she was seeing me, I felt she had not come prepared which translates to "doesn't care." I was reminded of the times I did the same thing, but it didn't really make me feel better about the doctor, just horrified at my lack of personal insight. It would be great if Siri could be developed in this way!
- Clinician: "Siri, Mrs. Jaques is in 104, isn't she?"
- Siri: "No, that is the room for Mr. Peter Jones. Mrs. Ilene Jaques moved to 106 after surgery yesterday."
- Clinician: "Siri, can you provide the surgical summary, please? What are her labs this morning? What type of pet does she have? Please tell me its name as well."
Oh, what bliss it would be.
Maybe the computer voice could be even more! I really like the idea of a droid that follows us about, ready to listen and transcribe our notes. We could call it R2D2, though maybe Hal would be more appropriate!
Precision Medicine Initiative. U.S. Food and Drug Administration website. https://www.fda.gov/ScienceResearch/SpecialTopics/PrecisionMedicine/defa.... Updated October 3, 2016. Accessed February 10, 2017.
About the Author
Margaret Heale has a clinical consulting service, Heale Wound Care in Southeastern Vermont and draws on her extensive experience as a wound, ostomy and continence nurse in acute and long-term care settings to provide education and holistic care in her practice.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.