A whole-of-patient approach to medicine

With admirable persistence, Western medicine has maintained its Enlightenment-era view of the human body as a machine, a mechanical mass reducible to interlocking and interchangeable parts. This view has been updated over the years to include hormones and genes and micro-organisms, but the basic idea has stayed the same. One effect of this is that advanced doctors today are specialists in one narrow area. If you have a problem with your heart, you see a cardiologist.

There are obvious benefits to this approach. When I’m suffering with debilitating hay fever, you better bet I’m seeing an allergist, who can tell me precisely which blossoming trees or grasses I might avoid, and what remedies I might try when I can’t. A cardiologist is simply the wrong person to ask.

But there are disadvantages too. The mechanic’s mindset has caused a lack of synthesis between the branches of medicine. A patchwork approach to treatment may address part of the problem but not the whole. Or it may address the problem only when it manifests in symptoms, instead of trying to prevent it altogether. Some specialties focus more on root causes than others, or each may focus on different causes. To treat chronic fatigue, do you need an endocrinologist, a cardiologist, a sleep therapist, a nutritionist, or a psychiatrist? If you need more than one specialist, how do you deal with the fact that they don’t talk to each other? And could you have prevented your fatigue altogether if you had known sooner that something in your body hadn’t developed properly when you were a child?

A counterweight to the mechanic’s mindset might be found in the budding field of precision medicine, which seeks to optimize and personalize treatment based on a patient’s unique genetics. The idea is that, if your chronic fatigue has a genetic basis, as many health problems do, you might be able to find out before symptoms appear, then develop a tailor-made approach to preventing them, instead of depending on a one-size-fits-all treatment after symptoms become unbearable.

But this is still largely hypothetical. Thus far, precision medicine as a whole has followed the mechanic’s mindset by focusing on single genes corresponding to single health concerns, such as heart disease, depression, and Alzheimer’s. These applications are undoubtedly useful. But because DNA is where a large number of health problems converge, precision medicine could also be used more holistically.

There are some efforts underway in this direction: functional medicine seeks to develop patient-specific treatments based on genetics and other root causes; maternal–fetal precision medicine hopes to identify and treat genetic and anatomic birth defects in the womb. But applications in these fields thus far are prohibitively expensive in most cases, or are less useful past a certain stage of our development.

Two strategies could help. First, there are some, though few, genetic tests that aim to give an integrated view of a patient’s health rather than simply testing for condition-specific applications. To encourage more widespread development of these tests, patients and doctors should take advantage of already available precision medicine tools.

Second, there is a need for new technology that is capable of accounting for more genes. A startup or research team could compile existing precision medicine applications into a unified platform — for example, a program that synthesizes a patient’s results from separate genetic tests and offers additional analysis of its own. This would permit a health care provider to see the connections between genes throughout a patient’s genome and offer integrative solutions.

Precision medicine is promising, but it is also nascent and vulnerable to misdirection. Now is the time to pursue intentionally holistic approaches, while the field can still develop in a way that counterbalances rather than exacerbates the mechanic’s mindset in medicine.