Personalized medicine and patient safety: two sides of the same coin

DNAPersonalized medicine is getting a lot of attention, and rightly so. We all have our own DNA, health habits, socioeconomic background and values. Shouldn't the care we get be personalized for us? Basic scientists have provided profound insights about the incredible complexity of disease—for instance, about how breast cancer is not a single disease but comes in one of many forms. The specific type of cancer may determine the patient’s prognosis and which drugs are likely to be effective. Our unique genes also affect how we metabolize certain drugs, a factor that can increase the risks for severe overdosing or underdosing.

Some clinicians may view personalized medicine as opposed to patient safety and quality improvement efforts, which focus on creating protocols and checklists and ensuring that all patients get the same therapy for a given clinical situation. While standardizing work leads to better outcomes for populations, physicians may push back, viewing safety and quality approaches as “cookbook medicine.” They claim that caring for patients is far too nuanced to be reduced to a checklist or protocol.

Yet efforts at personalized medicine and quality improvement are united in a common goal: optimal patient outcomes. They just approach it from different angles. Quality improvement standardizes work when possible, leaving clinicians to focus on the complex, patient-specific situations in which their expertise, analysis and skills are most needed.

Personalized medicine (largely genetics) has taught us that we can no longer allow the patient’s disease alone to define appropriate treatment. We must also view the patient’s specific genes as defining appropriate therapy, when that genetic knowledge is available. However, without also focusing on patient safety and quality, these medical advances will increase the risk of error. Right now, patients receive roughly half of the recommended therapies for common diagnoses that physicians see every day, such as urinary tract infections or diabetes. Imagine the number of permutations of recommended therapies (and thus the risk for error) that would exist if we needed to start remembering that a disease with one gene gets Treatment A while the same disease with another gene gets Treatment B. Diagnostic and therapeutic errors will skyrocket if we do not couple these advances in basic science with similar progress in health care delivery science. This often neglected field shows us how to take existing scientific knowledge, translate it into everyday bedside practices and implement it on a large scale. We need a cadre of experts who look at the breathtaking discoveries coming out of laboratories and clinical research and find a way for patients everywhere to consistently benefit from them. That is the promise of medicine.

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