Monday, August 2, 2010

Treat the patient, not the disease

Henry A. Nasrallah, MD


Personalized care is at the heart of good medical care. It is an indispensable ingredient for optimal clinical outcomes because each patient is unique, as an individual and as a patient, and requires customized treatment.

If 10 patients with depression walk into a psychiatrist’s office on any given day, each will be different and should be treated accordingly. Their symptoms may be similar thematically but they differ widely in presentation and content. Their medical and psychiatric histories and social, educational, religious, ethnic, socioeconomic, and attitudinal diversity can be stunning in complexity and disparity. Just as patients’ symptoms can be similar yet different, so can their response to a specific antidepressant or psychotherapy. Their clinical and functional outcomes will vary widely in degree and valence. Every psychiatrist expects (and enjoys) the richness of patient backgrounds and manages each individually.

Given these individual differences among our psychiatric patients, why are practitioners being barraged by various entities to abandon the traditional medical approach to their patients? Why is there a push to transform personalized clinical care to an assembly-line system, where patients are defined by their disease and are managed like “human widgets” as though they can be “processed” in an identical, protocolized, mechanical manner? This is completely antithetical to the magnificent personal approach inherent in the classic and highly effective doctor-patient relationship.

1 comment:

  1. Professor Nasrallah's comments echo the voices of most practicing psychiatrist on both sides of the pond. Apart from deluge of guidelines (yes we are guilty of having produced some too!), very necessary but misunderstood and indeed misused by service providers in UK NHS. What is even more alarming here in UK is how there has been proliferation of psychiatric teams involved in the care of an individual with psychiatric problems, leading to the disruption at worst confusion (sometimes dangerous) in psychiatric care.
    I do believe there is need for injection of some common sense, acceptance of the basic tenant of good medical practice, that is individualised care so that the old joke about how many psychiatrist it takes to change the light bulb does not turn in to how many psychiatrist does it takes to help a patient with psychiatric problems.

    Dr Rashid ZAMAN
    BSc (Hons) MB BChir (Cantab) DGM MRCGP MRCPsych

    Consultant Psychiatrist & Director BCMHR-CU
    Hon. Visiting Fellow, University of Cambridge