Through a patient’s eyes, is “precision” medicine truly “personalized” medicine?

In the cover story “The Future of Medicine” in the January issue of National Geographic magazine, journalist Fran Smith and photojournalist Craig Cutler explore the remarkable promise of gene research and treatment.
“It’s a very simple principle,” commented Razelle Kerzrock, an oncologist and director of the Moores Center for Personalized Medicine, in the article. “You pick the right drugs for each patient based on the tumor profile, not based on a part of the body or based on what type of cancer 100 other people have. It’s all about that patient sitting in front of you.”
Precision medicine. Individualized medicine. Personalized medicine.
The breakthrough treatment options made possible by gene research are already being branded by a number of different creative names. But while these approaches may indeed be precise and individualized, does the identification of a more unique treatment regime alone make care truly personalized in the eyes of the patient?
In a commentary in the November 22 issue of The New England Journal of Medicine, authors Stacey Chang, MS, and Thomas Lee, MD argue that the interpersonal communication aspects of care are crucial to higher quality, compliance and a patient’s overall engagement and experience. While their commentary focuses on the advantages and limitations of evidence-based medicine (EBM), the central points perhaps apply even more significantly to precision medicine.
“EBM placed new emphasis on the relationship between clinical research and clinicians’ practice patterns but shifted medicine’s ‘center of gravity’ away from the space between clinician and patient to somewhere between research and clinician,” the authors submit. “Real progress has been made, but something has been lost, and we believe it must be recovered.”
In our practice at Stamp&Chase, we emphasize the essential interpersonal communication competencies and practices that lead to improved patient engagement, better outcomes and safer care. Like the miraculous treatment options made possible by gene research, we believe that focused, individualized conversations with patients improve diagnosis and therapeutic interactions.
Following are three specific suggestions for making the care we provide far more personalized.

Start with an empathetic communication mindset

Like the oncologist in the National Geographic article so aptly pointed out, “It’s all about that patient sitting in front of you.” Empathetic communication starts with the seemingly straight-forward but often complex goal of really understanding the patient in front of you – where s/he is both physically and emotionally, and what s/he needs most.
Empathetic communication does not start with well-crafted empathy statements. While there is a role for helping caregivers learn to respectfully express empathy, encouraging a scripted response before you really do understand is as ineffective, hollow and disrespectful as saying, “I know how you feel.”

Listen more; talk less

Empathetic communication is impossible without active, non-judgmental listening. And our listening must, at least initially, be on the patient’s terms.
As Dr. Robert C. Smith, who is a long-standing authority on effective communication in health care, points out in one of his early articles in the Annals of Internal Medicine, “In the patient-centered interview, patients lead the exchange. The patient generates ideas and controls the direction of the conversation. The physician follows the patient, much as one follows a dance partner.”

Ask more – and better – questions

While the patient should take the lead – especially early in the interaction – a caregiver’s questions often provide the encouragement and reassurance a patient and/or family members need to engage in a conversation that is most beneficial for them and for the care team.
How often do we hear a patient say, “I don’t even know what to ask,” especially after an overwhelming, unexpected or devastating diagnosis. The caregiver’s reassuring questions can open the door to better, more complete clinical communication and emotional/social support.

  • “Tell me about what’s worrying you most right now.”
  • “This is a lot of information to take in all at once. How can I help you most?”
  • “Most patients have questions about this aspect of care at home. Are there things you’d like to ask or talk about related to that?”

Like gene testing and the most advanced imaging technology provide precise diagnoses for better clinical care, great questions provide caregivers with the most individualized insights for compassionate, holistic care. Only when both evaluations are pursued equally will a patient truly receive unsurpassed personalized care.