Patient – Doctor relationship in the age of precision medicine. 13
This is very interesting trend. The quantification of imaging technologies, the standardization, the integration of online tools. Dr. Anton Titov, MD. It all points out to precision medicine that is becoming available to more patients. But perhaps there is an additional trend. This is very relevant for patients around the world. Dr. Paul M. Matthews, MD. It is the fact that treatment of many chronic diseases, including multiple sclerosis, becomes more decentralized. Dr. Anton Titov, MD. Patients have more control over their treatment. Patients have more knowledge about their disease than ever before. Dr. Anton Titov, MD. Can you please comment on the trends in patient care? Perhaps you can place an emphasis on multiple sclerosis. Well, Anton, you’ve asked a huge question. Dr. Paul M. Matthews, MD. I will try to be brief simply to indicate how difficult it is to capture the whole problem. I think it is precisely as you say. Medicine over the last 30 years has profoundly changed from a service delivered by doctors in hospitals to patients. Medicine now is an active engagement between patients, hospitals, and doctors. All of them collaborate in creation of a plan for improved health. This notion of the patient as being a partner to those traditionally delivering service is well recognized now. Dr. Paul M. Matthews, MD. The availability of extensive information on the disease in general has grown. Information about treatment options is available to patients and their families via the web. It has an immediate impact on the nature of the doctor-patient interactions. In my experience, interactions between patients and physicians are now usually done from a standpoint of considerable mutual understanding of a problem. Dr. Paul M. Matthews, MD. Sometimes patients come in with a far greater understanding of multiple sclerosis medication or aspects of the problem even than knowledge of their doctor. It is particularly true when the physician is not a specialist. This is really fundamentally changing the way in in which patient care is accessed. It is changing the ways how treatment decisions are made. At same time there is an increasing need not just for general data on patient’s disease. There is a demand for specific data on the particular patient. Dr. Paul M. Matthews, MD. This is a patient whose problem is being addressed in the clinic now. How does their course of disease relate to course of disease in other patients? Dr. Anton Titov, MD. What that might mean for their specific treatment? This is, of course, the realm of personalized medicine. It is the realm of precision medicine. The initial dream of personalized medicine was to frame it very much in a genetic context. Precision medicine was meant for complex disorders such as multiple sclerosis. It is quite clear that this is not going to be so easy. Genetics may contribute, but many other factors need to be taken into account to understand individual prognosis in patients with multiple sclerosis. We only begin to assess individual response to the treatment. Doctors and patients are increasingly recognizing the need to consider all of the medical background for patient. We have to consider the laboratory data. Dr. Paul M. Matthews, MD. Importantly, we have to consider what the patient’s expectations and preferences are in choosing treatment options. The final point I want to emphasize is that implicit part of what I just said is this. Dr. Anton Titov, MD. Patient preferences are playing a role. This is something that is, remarkably, a rather new idea. Healthcare systems, doctors are recognizing this consequence of patient engagement. Dr. Paul M. Matthews, MD. The success of therapy demands focus on what patients think they’re going to get from the therapy. We must recognize what patients need to have from a therapy or from treatment program. We must know what patients need in order to continue to live the kind of life that they wish. I think these are all very welcome developments. Dr. Paul M. Matthews, MD. We are going to see more and more tools for better capture of how patients are feeling. How patients are functioning in the real world. What patients expect from treatment. So that we are treating patients for quality of life rather than to improve or repair biomarkers. It is going to be an exciting period to watch.
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