This week, Brett Newcomb and I discuss the differences in two different approaches to medicine and patient care. We discuss which is preferable between medicine that is personalized, and medicine that is directed by guidelines and hierarchically-mandated standards.
Which of these options sound better: receiving medical treatment from a physician that treats you as a unique individual, or visiting a doctor who follows an algorithm and gives you the same treatment as his or her last 200 patients? A recent article in JAMA—the Journal of the American Medical Association—discussed the topic of philosophical approaches to practicing medicine. The two schools of thought that the article compared were: 1) practicing medicine by following established guidelines of the various medical specialty organizations, or 2) addressing each patient as an individual based on their sex, genetics, habits, exercise regimen, and jobs; and determining the best medical care for each patient.
The specialty groups that oversee doctors establish supervisory boards that determine the advised treatment for each problem cared for within that specialty. This treatment is meant to be the lowest level of treatment that is required to meet the standard of care, which is a legal term. Many physicians limit themselves to these guidelines in their practice, not realizing that they are meant to be a “minimum” level of care. However, in sticking to this minimum level, they follow a narrow path in their treatment. They are concerned about their exposure to liability lawsuits and believe that the governing body knows, in its collective wisdom, the best way to proceed—by treating each patient in the exact same way. Other doctors realize that not every patient is the same and they decide to adhere to the guidelines while focusing on what is called “personalized medicine.” Personalized medicine offers an individualized approach. The doctor pays attention to the patient by speaking with them, learning their history and their lifestyle concerns, and developing an individualized treatment plan. This plan may or may not adhere as strictly to the specialty guidelines. These doctors follow this path with the consent of their patients, who generally feel pretty good about the doctor spending time with them and using both the “science” and the “art” of medicine.
Often, doctors will encourage a patient to bring an additional set of ears—such as a wife, a daughter, or a good friend—to help by listening and by reminding the patient to follow the protocols that the doctor establishes for the treatment plan.
Another interesting consideration when trying to decide what type of medical focus to have (either the personalized or the guideline-structured style) is whether emergent/acute care medicine or lifestyle/preventative medicine should be used. Acute care medicine requires more structured and immediate responses to deal with an emergency. Preventive care allows for more time to develop a better long-term lifestyle pattern for the patient so they can avoid illness.
Listen to our podcast this week to engage your own thoughts about how to look for and find the type of physician who makes you feel safe and comfortable while dealing with your illnesses as well as avoiding problems in the future.