{"id":33767,"date":"2015-03-25T17:20:29","date_gmt":"2015-03-25T16:20:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=33767"},"modified":"2015-09-22T14:27:25","modified_gmt":"2015-09-22T13:27:25","slug":"william-cayley-about-what-are-we-being-precise","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/03\/25\/william-cayley-about-what-are-we-being-precise\/","title":{"rendered":"William Cayley: About what are we being precise?"},"content":{"rendered":"

\"bill_cayley_2\"<\/a>I\u2019ve been too swamped with the day to day realities of teaching, patient care, and just plain real life lately to be very reflective, but Zackary Berger and Dave deBronkart<\/a>\u00a0finally spurred me on to put fingers to keyboard, and put words to my thoughts on the nascent move towards \u201cprecision medicine.\u201d<\/p>\n

From the first, when I heard of Mr Obama\u2019s precision medicine initiative<\/a>, I was underwhelmed (at best) and fearful of more misdirected use of resources at worst.<\/p>\n

We are currently working daily through the challenges of the Affordable Care Act (ACA)<\/a>, which on the plus side has made healthcare coverage available for many people who had none before, but on the downside it has added paperwork, reporting, and mandated screenings that I cannot see doing anything other than increasing workload without any clear benefit. (To wit, we are now required to annually screen older patients\u00a0for falls risk and depression risk\u2014these are real and serious problems, but I cannot think of a single patient for whom these screenings have told me something I did not already know, or helped me help my patient in a better way.)<\/p>\n

Beyond my worries about excessive mandates, I am also concerned about the increasingly tarnished reputations of some of the \u201clatest and greatest\u201d in medical ventures. One has to look no further than recent writings in The BMJ<\/em> on rosuvastatin<\/a> or oseltamivir<\/a> to be reminded that new developments can be oversold. The \u201cToo Much Medicine\u201d campaign<\/a> has been shining a helpful conceptual light on our penchant for doing more and more, and more expensively, without helping our patients live any longer or better (or perhaps, even at the risk of increased harm to our patients).<\/p>\n

I am not completely anti-innovation. I recently lost a friend to cancer at too young an age, and I\u2019ve had several patients benefit from novel therapies or newer, less invasive surgical techniques. At the same time, however, I deal daily with patients who cannot afford their medications, or who don\u2019t want all the pills the guidelines tell us we need to recommend, or who are skeptical about the screenings we tell them to get. I also daily see patients whose health would be improved best by better local areas to exercise, or by better availability of healthy food choices. No amount of personalized genomics can address those challenges.<\/p>\n

\u201cTech\u201d can be wonderful (I\u2019m certainly happy for our dishwasher at home). \u201cTech\u201d can also be enthralling (ie, enslaving\u2014how many teens do you see each day with faces glued to smartphones or other video entertainment?).<\/p>\n

I really hope we can continue to innovate and advance in medicine, and I do hope we can find ways to treat the cancers, infections, and other diseases that claim the lives of our patients\u2014and friends and families. But I also hope that we can work just as hard at understanding our patients, partnering with our patients, helping our patients find ways to live more healthily (perhaps even more happily), and finding creative ways to care for those who just need a hand meeting their most basic health needs.<\/p>\n

True \u201cprecision\u201d medicine is not just about \u201cprecision\u201d molecular biology, but precision “biopsychosocial<\/a>” care for the whole person.<\/p>\n

William E Cayley Jr<\/strong>\u00a0practices\u00a0at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.<\/em><\/p>\n

Competing interests:<\/strong>\u00a0I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.<\/p>\n","protected":false},"excerpt":{"rendered":"

I\u2019ve been too swamped with the day to day realities of teaching, patient care, and just plain real life lately to be very reflective, but Zackary Berger and Dave deBronkart\u00a0finally […]<\/p>\n

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