Читать книгу Discovering Precision Health - Lloyd Minor - Страница 16

In the “high touch” environment we want to develop, physicians will return to some of the wisdom of figures like William Osler. Doctors need to recognize the intimate bonds with their patients when performing hands‐on examinations and listen to their concerns with empathy. This is part of a time‐honored ritual and enables health professionals to gain critical information that differs from what they learn through lab tests and radiological scans. This kind of rich, nuanced data—what is important to patients, what they fear, how their symptoms manifest and how they feel—must also factor into a truly holistic approach to health care. As my Stanford colleague Abraham Verghese has written, “True clinical judgment is more than addressing the avalanche of blood work, imaging and lab tests; it is about using human skills to understand where the patient is in the trajectory of a life and the disease, what the nature of the patient’s family and social circumstances is and how much they want done” [7].

Precision Health can—and should—strengthen the doctor‐patient relationship, and it should allow each of us to be more participatory in decisions as well as activities that have an impact on our health and wellbeing. As Stanford’s Sanjiv “Sam” Gambhir points out, Precision Health

creates an opportunity for the entire health care team, including physicians, to utilize more detailed and comprehensive health data sets to be better informed about their patients’ individualized health. In turn, it allows physicians to more accurately address their patient’s health risk profile and tailor monitoring methods and early intervention to that individual. This type of approach will empower doctors to be more focused and directed in how they treat patients [8].

For patients, says Gambhir,

increased health monitoring allows them to more proactively engage in their own health—in some cases in real time—and see how it relates to their lifestyle and other health factors. Rather than simply follow a standard appointment schedule, patients would only visit their physician when needed, but they could still have contact with their health care team through a secure health portal [9].

The emphasis on “high touch” is complemented by a focus on “high tech.” Technology has spawned new fields like genomics, nanoscience, regenerative medicine, and biomedical data science. It is enabling health care professionals to piece together a high‐resolution picture of human health at the population level. Euan Ashley, a professor of cardiology at Stanford, explains, “The fundamental concept of precision health is the idea of defining disease better in order to target it more precisely. And how do we define disease better? We do it with new technology. If you look at the history of medicine, we’ve always defined disease according to the state‐of‐the‐art tools of the time.” He points out that in decades past, a cardiologist sought to diagnose heart disease by listening to the sounds coming through the stethoscope. “But when someone invented the electrocardiogram, we started to define heart disease according to the electrical signals from the heart” [10].

The ultimate objective of Precision Health is not just to glimpse the finer details of health and disease—it’s to consistently track and actively apply the findings to detect disease earlier, if not prevent it altogether [11].