On an almost-daily basis, we are witnessing marvelous advances in biomedical science. Thanks to discoveries in genomics, proteomics, metabolomics, and in other fields, patients are increasingly receiving treatments designed to work precisely and personally for them. Yet it is also true that all the “omics” in the world cannot deliver the promise of medicine unless physicians also know their patients as people. A person’s goals, hopes, fears, barriers to care, psychological state, and financial and family resources always must be considered in designing effective treatments. In short, for patients to receive the best care, detailed knowledge of the patient as a person, or “personomics,” must be viewed as a part of precision medicine.
The American Journal of Medicine is therefore pleased to announce it is launching a new series entitled Personomics (a neologism recently coined by one of us [RCZ]1) that would allow contributors to describe, in 1500 words, examples of how knowing the patient as a person helped solve a diagnostic enigma, designed a treatment plan for a given individual, fortified the patient’s dignity, illustrated the hazards of making assumptions about people, or added awe and wonder to the daily work of a doctor.
The National Institute for Health and Clinical Excellence (NICE) guidelines for getting to know patients as people2include the following domains:
- The patient as an individual
- The patient’s life circumstances
- The patient’s concerns
- The patient’s needs and perspective
- Don’t make assumptions
Many busy doctors reading this Journal have had experiences that illustrate the importance of each of these. We certainly remember the 60-year-old “office worker” the residents presented on Chiefs Rounds at Johns Hopkins in September 2005 who had been having “unexplained” exacerbations of asthma the same time each year. The mystery was solved when it was discovered that the patient lived in New York City and not Baltimore, and that she had been in her “office” in the Twin Towers of the World Trade Center on September 11, 2001 when the planes hit!
We also recall the middle-aged truck driver who presented to our Baltimore Emergency Department with a multisystem disease that evaded diagnosis until he was asked, “What do you think is wrong?” Jaws dropped when he said “coccidioidomycosis,” an infection that pops up often in Tucson but rarely in a mid-Atlantic city. Turns out he was right! He had driven through Southern California shortly after one of the earthquakes, and had learned about “valley fever” from reading about other cases reported in his truckers’ newspaper.
And we will never forget the patient with liver failure and frequent admissions for longstanding and assumed refractory noncompliance who was prodded to change once a physician learned that what really mattered to the patient was not his own health but the care of his cocker spaniel, Lady. The patient became compliant once he realized that taking his medications would mean fewer kennel stays for Lady!
Osler articulated an enduring truth when he observed that “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”3 We hope that the Journal’s new series on Personomics will illustrate that precision medicine and personal medicine are required to deliver the full promise of medicine.
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-David B. Hellmann, MD, Roy C. Ziegelstein, MD
This article originally appeared in the June 2017 issue of The American Journal of Medicine.
