Betty Chaffee/ July 26, 2018/ Medication Management, Medication Therapy Management, Personalized Medicine, Precision Medicine/ 0 comments

 

Everybody is unique. We all have our own personalities, lifestyles, environments, and genetics. We may enjoy the same things as someone else, or not. Our bodies may respond to a particular medical treatment more efficiently than someone else’s, or not. It’s important that healthcare providers see each patient as an individual rather than as a disease that needs treatment. But how do we make that happen?

Personalized medicine allows the treatment to fit the person.

Medicine historically grouped people into categories based on their health problems. There were diabetics, hypertensives, heart failure patients, cancer patients, and others. Typically a diagnosis would be made, and a plan to treat the disease would be implemented. The doctor would explain to the patient what needed to be done to bring the disease under control, and the patient was expected to comply. Historically, patients were reluctant to ask questions of doctors, and doctors often were surprised when their treatment regimens were questioned. A prescription might be written by the doctor in Latin so that only the pharmacist could decode it and put recognizable instructions on the label.

Personalized medicine brings the patient back into the treatment decision. Lifestyle, environment, and genetics are all important pieces of the process. Genetics can be tested and documented. Environment can be discussed, and maybe altered to prevent disease. But lifestyle is often changing, sometimes not apparent, and many times neglected in the conversation. Whose job is it to make sure lifestyle issues are discussed and prioritized when making treatment decisions?

It’s all about patient-provider communication!

Communication is the key to making medicine personalized. Healthcare providers can’t know what people are able (and willing) to do unless it’s discussed.

Here’s an example: Let’s say the first line of treatment for Jane Doe’s high blood pressure is diet and exercise. Her doctor comes up with a detailed treatment plan for her to eat right and what types of exercise to do. That may be the right call for the majority of people with high blood pressure. While the plan is being written up and talked about, all Jane is thinking is “there’s no way I’m going to be able to exercise that much because my knees always hurt after work and I need to rest.”  But she doesn’t say that to her doctor. So she leaves the office with a treatment plan she knows she won’t be able to put into effect. At the follow up visit  three months later, her blood pressure is still high and her health hasn’t improved.

What if Jane had explained that she doubted she could adhere to the exercise plan? It’s possible that her doctor would be surprised that she’s questioning his treatment plan, or in a rush to get to the next patient. But more likely her doctor might have responded by asking whether a smaller amount of exercise would be do-able. Together, they might have come up with a plan to start an exercise plan more slowly, something Jane could do. Or maybe exercise is off the table completely, at least for now, and a different plan needs to be made. Either way, there’s a better likelihood that Jane’s blood pressure will be lower at the follow-up visit if she leaves the office with a treatment plan she believes she can work with.

Let your healthcare provider know who you are and how treatment plans might fit your life (or not).

There are plenty of other examples of things that should be discussed with healthcare providers. What if an injectable medication is prescribed, but you’re squeamish and reluctant to use an injection? What if your doctor prescribed a medication that needs to be take three times a day and you know you just can’t fit the middle dose in due to your work schedule? Or your doctor wants to prescribe a medication but you’d prefer to try diet and exercise first? Bringing up your concerns will allow for a discussion about alternative treatments, their pros and cons, and can only help you and your healthcare provider to be on the same page, working toward the same goal.

Always ask what the treatment goal is.

It’s important for people to know what goal their healthcare provider has in mind when coming up with a treatment plan. Why? Because in the same way a treatment has to fit the person rather than the disease, the goal of treatment needs to fit the person too. And, at least as important, the goal needs to be agreed on. It doesn’t make sense for a person to start on a treatment plan with a different goal in mind than the doctor. 

For example, if our Jane Doe is prescribed a medication for her joint pain, and the doctor’s goal is for her to be able to walk just a little further without pain, but her goal is to be totally pain-free, they’ll be working at cross purposes. She may call the office to get a prescription for a stronger medication and may be told “no”, but not understand the reason for that decision.

Don’t be afraid to ask questions, and keep asking until the answers are clear.

I’ve had many clients tell me that they are reluctant to ask questions of their doctors. There are common reasons – the doctor is too busy; the doctor may get angry; it might be a stupid question. There are plenty of reasons. for not discussing treatment decisions with our providers. But when discussion doesn’t happen, personalized medicine won’t happen, either. Much of the responsibility for making healthcare personal lies with the person

Be the person who makes your healthcare personal!

And remember, a pharmacist specializing in Medication Management can be of help when questions about medication do go unasked or unanswered. Contact BetterMyMeds to get the maximum health benefit from your medications!

 

 

 

Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
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