3 Shifts In Healthcare That Will Put the Person Back Into Personalized Medicine
By Hien Nguyen & Prakash Menon
We already know that personalized medicine is the next frontier in medicine — the term, which first appeared in publications as early as 1999, has finally hit the mainstream. President Obama unveiled the Precision Medicine Initiative earlier this year, and colleges around the country have formed dedicated precision medicine centers. Companies such as 23andMe have caused a spike in consumer awareness and curiosity in personalized medicine and its potential impacts.
Despite this increased momentum, the enormous power of individualizing care based on a patient’s unique genomic profile and other highly specific health data is still in its early stages. But the reason we’re not there yet doesn’t have to do with limitations on the technology or the genomics — of course, we’re not at the tipping point yet, but innovation in these areas is growing faster than ever.
The limitations in how quickly and effectively personalized medicine can take hold has more to do with systematic constraints rather than a lack of innovation.
Healthcare as a system is practiced in such a way that it cannibalizes the health providers’ efforts to focus on preventive care and individualized medicine. Ironically, it lacks the “person” in personalized medicine.
We have become so enamoured with the data, that the rest of the system has to catch up. We have advanced tools to determine what a person’s particular risk factors may be, now extending right down to the genetic level. But then what? What the system currently is trying to catch up on, is a way to help people engage, be educated and ultimately make the required changes to alter their health trajectory from sickness to one of wellness.
We’ve laid out what we think are the three most important system-level shifts that must take place in order to accommodate this new form of care.
We have standards of care, now we need best practices for wellness
Every year, we spend a whopping $2 trillion treating chronic, preventable diseases like heart disease, diabetes, and lung cancer. This dollar amount, and the fact that our country doesn’t seem to be getting any healthier, has prompted a call for more preventive care and a new focus on long-term wellness.
While this is a positive shift from the perspective of improving long-term health and driving down high-cost medical interventions, the reality is that doctors simply don’t have the tools to efficiently and effectively practice what we’ll call “lifestyle” medicine or wellness care.
Doctors today know how to treat sick patients, but they are still lacking support in the latest approaches to preventive and personalized care, as evidenced in a study showing in some cases, less than 1 in 5 physicians were following guidelines surrounding lifestyle recommendations and preventive care.
For example, nutrition is the most important factor in helping people with diabetes and insulin resistance see improvements. For decades, studies have shown that a diabetic person who conscientiously followed a specific cardiometabolic diet, could dramatically improve, and in some cases reverse the pathophysiological changes that drive diabetes. While it’s true that some patients need slightly different variations on this diet based on specific genetic markers, what is even more important in the grand scheme is finding ways to effectively and efficiently support the patient to make those often difficult changes that impacts their lives in every waking moment.
Yet, a recent study showed that nutrition education in medical schools has actually declined to a dismal 19.6% of medical students getting the recommended tutelage in this keystone area of wellness.
Behavior change is difficult — it’s the primary barrier keeping us from unlocking the power of preventive care at scale. A health coach, dietician or physician needs methods, techniques and tools for communication that help a patient make small changes, move towards mutually agreed-upon goals, and track progress.
Best standards of care in lifestyle and wellness medicine already exist through leading bodies like the Institute of Functional Medicine and the American College of Lifestyle Medicine — the next step is to get them in the hands of providers.
From doctor-centered care to patient-centered care
In essence, we have to shift our priorities and zoom in on the individual patient. Patients have long taken the backseat when it comes to their own care decisions. The average doctor-patient interaction is 8 minutes long — hardly enough time for a discussion about their diagnosis after a check-up, especially when you consider that 40–80% of all medical information is forgotten immediately. It’s no wonder that patient adherence to wellness plans is woefully low — 50% or less.
When patients feel like they don’t have control over their care or can’t understand their diagnosis and treatment, what motivation do they have to keep up with doctor’s orders?
It’s not a one-way street. Physicians and health coaches have to understand the complete health profile of each patient, including their lifestyle habits, while patients have to have a sense of agency in their care in order to actively engage and make positive changes. Patients, just as much as physicians, have to understand the “why.”
In more specific terms, this means that health coaches and physicians have to adopt a communication style and approach that caters to patients’ cognitive ability and education level. One example of this is motivational interviewing, a method of collaborative communication that strengthens an individual’s desire and commitment to positive behavior change by aligning behavior change to their own personal goals in their lives, relationships, and vocations
These vital communication skills aren’t currently emphasized in medical school, but they ought to be added to the curriculum.
It’s time to think about healthtech in a new way
At Techonomy Bio 2015, Susan Desmond-Hellmann explained that one of the biggest and most frustrating barriers in healthtech is that technology has come so far to optimize other areas of life, but patients and healthcare consumers have been left underwhelmed by how little technology actually does for everyday health and wellbeing.
Part of the problem is that despite the intense momentum in healthtech (investments are on track to reach an all time high again this year), all of the noise is making it easy to forget that technology is not a silver bullet. Healthcare is still a profoundly personal, human industry. Throwing more technology at the problem in a reductionist manner without keeping in mind the wonderful complexity of patients as human beings makes the same error biomedical science has made for several decades, and has resulted in the most ineffective, inefficient care system in the world.
We should be thinking about technology in healthcare not just as a tool for a specific purpose, but as an enabler of change, centered around humans. That’s why the term “patient-centered care” has never been more prevalent as it is today. Technology, when used well, can make healthcare more accessible, by connecting patients to trained wellness providers that are currently hard to find in today’s marketplace. Remote monitoring tools, biometric tracking, action plans and communication portals can improve engagement, by helping patients stay more closely in touch with and therefore engaged in their care, but only if it is designed to meet patients where they are and not where we want them to be.
Looking ahead, we should be inviting patients and providers to take part in the process and be generous participants collaboratively in a holistic approach to change, not just ask them to adopt the latest tools. That is when change meaningfully happens.
The heart of it all: engagement
Patient engagement, activation, and adherence is at the heart of the changes needed to allow for more personalized and effective care. Health Affairs has dubbed patient engagement as “the blockbuster drug of the century,” for its ability to radically improve outcomes and decrease costs.
To realize that holy grail of medicine, we need a healthcare system is that is inherently motivating, engaging, and individualized. With the advances in technology and some of the above mentioned changes already in motion, we are hopeful that world is just around the corner.
Hien Nguyen is the CEO of Vitalyze.Me, a premier digital wellness platform. Prakash Menon is the CEO of BaseHealth, the precision health and wellness company. This month, the two companies partnered to integrate comprehensive health assessments into Vitalyze.Me’s platform and bringing personalized health management to their customers.
