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There is no question that precision medicine, defined as the use of genetic, genomic, and epigenetic information to ‘personalize’ therapeutic strategies is creating unprecedented opportunities for improving health care delivery (Denny et al., 2021). As the cost of genomic sequencing decreases, the speed at which such technologies are transitioning from ‘bench-to-bedside’ has quickened. Thanks to advances in biomedical informatics including enhanced cloud computing and deep learning algorithms to improve clinical decision support, physicians in the 21st century have a new toolbox of cognitive resources to support them at the point of care (Denny et al., 2021).
This tsunami of new technologies also brings to light new challenges, particularly with regards to data privacy, ethics, and the emotional well-being of those being treated (Goodman & Miller, 2021). For example, what are the consequences of a patient learning that he or she is genetically predisposed towards certain diseases, particularly in situations for which there is no known cure? How might this information impact family members who might share risk factors?
Importantly, how does access to such information impact the provider/patient relationship (Goodman & Miller, 2021)? Given such knowledge, providers may see themselves caught in a ‘Catch 22,’ between responsibilities for transparency and concerns for their patients’ psychological well-being. In such cases, what takes precedence: diligence or compassion?
All of these issues reinforce the importance of behavioral health in optimizing patient outcomes, and the increasingly crucial role behavioral health providers assume in care teams. As quickly as genomic medicine transitions from laboratories to patient wards, the integrated behavioral health model must evolve in consideration of the challenges listed above. In fact, the ultimate success or failure of these new technologies will hinge upon the ability of behaviorists at all levels of health care to optimize provider satisfaction and patient outcomes, in keeping with the Quadruple Aim.
These issues extend to population health. In the evolving field of preventative medicine, how does genomic research change obligations and concerns for health care providers? How do we strike an appropriate balance to achieve cost/benefit, not only in terms of clinical efficacy, but importantly, whole-person wellness? For example, how do we address privacy and confidentiality concerns with patients, particularly if data from EHRs is being mined for genomic research? Equally important is addressing behavioral health concerns that will inevitably arise when groups of individuals are identified as having risk factors for disease? How can we move patient education outside of the clinic and into the community? Are there community resources that could contribute to such efforts, and if so, what is the most efficient and effective way in which to mobilize them?
Precision medicine has created an opportunity for physical medicine and behavioral health to move beyond their respective silos in the interest of healthier, happier patients. As Sir William Osler, considered by many to be the father of modern medicine, once explained: the best physicians look beyond the disease to the patient, treating the patient first and disease second (Centor, 2007). Given these new tools, we may come closer to Osler’s vision than any generation before.
Centor, R. (2007). To be a great physician, you must understand the whole story. Medscape General Medicine, 9(1), 59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924990/
Denny, J., Tenenbaum, J. & Might, M. (2021). Precision medicine and informatics. In E. Shortliffe & J. Cimino (eds). Biomedical Informatics: Computer Applications in Health Care and Biomedicine (5th ed. pp. 941-968). Springer. http://www.springer.com
Goodman, K. & Miller, R. (2021). Ethics in biomedical and health informatics: users, standards and outcomes. In E. Shortliffe & J. Cimino (eds). Biomedical Informatics: Computer Applications in Health Care and Biomedicine (5th ed. pp. 391-424). Springer. http://www.springer.com