Patient Centered Care

The term personalisation is used increasingly and, as a consequence, has developed an increasing number of meanings.

One of the earliest uses was in the definition of Evidence Based Medicine. Although accused of being cook book medicine, the origination of Evidence Based Medicine emphasised the need to relate the evidence to the unique clinical condition to the individual patient and his/her values:

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients’ predicaments, rights, and preferences in making clinical decisions about their care.

Source: Sackett, D. L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., Richardson, W.S. Evidence based medicine: what it is and what it isn’t. BMJ 312 (p.71).

The model described is perhaps better illustrated as a diagram:

This emphasises the need to take into account patients and their values to effectively deliver patient centered care. In some ways the term personalized medicine or personalized care is analogous to the concept of customisation in industry, made famous by Toyota and Dell Computers, and more recently, by the Mini factory in Oxford.

Customisation uses the benefits of large-scale construction when it makes sense but then customises the products to suit the needs of the individual. More recently the term personalisation has been associated with the use of genomic information as though it were a new term, but genomic information is not qualitatively different from biochemical information.  It is just information that needs to be tailored to the individual and should make the treatment specific to the unique clinical problems of that individual.

Other terms that have been used to describe how medicine will be practised when genomic information is available are the terms ‘precision medicine’ and ‘stratified medicine’ but the term personalised is probably now the most commonly used term.

It is important to remember that personalisation is just as important whether there is no genomic information available, as when there is genomic information available.