MEDICINE OUTSIDE THE BOX
( continued from page 7 ) efforts seek to include more diverse subjects from across the world . Population level genetic studies are increasingly allowing researchers to stratify risk in populations with certain genetic variants and single nucleotide polymorphisms . Mendelian randomization trials present a new paradigm as “ nature ’ s randomized trials .” 6 These studies can identify new drug targets as happened with the PCSK9 inhibitors .
The rapid advance of DNA analysis continues to make individual genotyping more affordable than most patients ( and doctors ) might expect . Sequencing your entire genome currently costs about $ 300 , but most companies sequence the best-studied 0.2 % for $ 99-199 . Rather than dooming us to fate , knowledge about our genomes can unleash opportunities for primary disease prevention . Learning about genes that predispose to cancer ( BRCA ), genes that can guide cardiovascular and cognitive health recommendations through dietary changes ( Apo E ), or even how you metabolize caffeine can improve quality of life and longevity . With these advances we can even identify certain medications that will benefit patients the most based on their genetics . Companies like SelfDecode and StrateGene provide detailed analysis with individualized recommendations . Our patients will come to us with these reports , and many of you are likely already seeing this .
Conclusion
As leaders in health care , we physicians must stay up to date with the different technological and methodological advances that can help our patients attain better health , even if that means expanding our current scope of practice . 7 We should focus on wellness instead of sickness , salutogenesis instead of pathogenesis . 8 Dr . Martin Seligman led the American Psychological Association to the paradigm shift of Positive Psychology , asking “ What ’ s right ?” instead of “ What ’ s wrong ?” 9 We can facilitate optimal health instead of barely preventing overt chronic disease . We can assist our patients in their efforts to thrive instead of merely survive . We can use appreciative inquiry to focus on our patients ’ successes however small , rather than exercising our habit of excessive prudence to highlight where they fall short . 10 medicine . Jama . Jul 14 2010 ; 304 ( 2 ): 202-3 . doi : 10.1001 / jama . 2010.903
2 . Hanaway P . Form Follows Function : A Functional Medicine Overview . Perm J . Fall 2016 ; 20 ( 4 ): 16-109 . doi : 10.7812 / TPP / 16-109
3 . Beidelschies M , Alejandro-Rodriguez M , Ji X , Lapin B , Hanaway P , Rothberg MB . Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes . JAMA Netw Open . Oct 2 2019 ; 2 ( 10 ): e1914017 . doi : 10.1001 / jamanetworkopen . 2019.14017
4 . Psaty BM , Dekkers OM , Cooper RS . Comparison of 2 Treatment Models : Precision Medicine and Preventive Medicine . Jama . Aug 28 2018 ; 320 ( 8 ): 751-752 . doi : 10.1001 / jama . 2018.8377
5 . Ginsburg GS , Phillips KA . Precision Medicine : From Science To Value . Health affairs . May 2018 ; 37 ( 5 ): 694-701 . doi : 10.1377 / hlthaff . 2017.1624
6 . Thanassoulis G , O ’ Donnell CJ . Mendelian randomization : nature ’ s randomized trial in the post-genome era . Jama . Jun 10 2009 ; 301 ( 22 ): 2386-8 . doi : 10.1001 / jama . 2009.812
7 . Huecker MR , Shreffler J , Platt M , et al . Emergency Medicine History and Expansion into the Future : A Narrative Review . West J Emerg Med . Apr 4 2022 ; 23 ( 3 ): 418-423 . doi : 10.5811 / westjem . 2022.2.55108
8 . Jonas WB , Chez RA , Smith K , Sakallaris B . Salutogenesis : the defining concept for a new healthcare system . Glob Adv Health Med . May 2014 ; 3 ( 3 ): 82- 91 . doi : 10.7453 / gahmj . 2014.005
9 . Lianov LS , Fredrickson BL , Barron C , Krishnaswami J , Wallace A . Positive Psychology in Lifestyle Medicine and Health Care : Strategies for Implementation . Am J Lifestyle Med . Sep-Oct 2019 ; 13 ( 5 ): 480-486 . doi : 10.1177 / 1559827619838992
10 . Merriel A , Wilson A , Decker E , et al . Systematic review and narrative synthesis of the impact of Appreciative Inquiry in healthcare . BMJ Open Qual . Jun 2022 ; 11 ( 2 ) doi : 10.1136 / bmjoq-2022-001911
11 . Sizemore R , Huecker M , Shreffler J , Zaino M , Thomas A , Kelley J . Physician Path to Wellness . A Qualitative Investigation of Self-Reported Strategies to Shift from Detrimental Health to Optimal Wellness . American Journal of Lifestyle Medicine . 2022 ; doi : 10.1177 / 15598276221114314
12 . Fries CJ . Healing Health Care : From Sick Care Towards Salutogenic Healing Systems . Soc Theory Health . 2020 ; 18 ( 1 ): 16-32 . doi : 10.1057 / s41285- 019-00103-2
Dr . Dennison is an assistant professor in the UofL department of emergency medicine and also sees patients at Integrative Health Specialists . ( non-member )
Dr . Huecker is an associate professor and research director in the UofL department of emergency medicine . He also sees patients at Integrative Health Specialists .
We can turn this lens around to ourselves , taking care of and forgiving shortcomings in our own health . The path from poor health to wellness looks different for everyone , but we should lead our patients on this journey . 11 The call to focus on wellness instead of sickness applies to all physicians : generalists , specialists , proceduralists , thinkers and speakers . 12 Our scope of practice is the health and well-being of our patients , our peers and our communities . Let ’ s break open this box and work together .
References 1 . Lianov L , Johnson M . Physician competencies for prescribing lifestyle
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