Just over a decade has passed since Johns Hopkins cardiologist Roy Ziegelstein coined the term “personomics” in a widely cited editorial in Journal of the American Medical Association, in 2015. In so doing, he set off soul-searching within the U.S. medical community, inspiring doctors and medical leaders to confront a painful reality: Given all the things that clinicians must do in a relatively brief time, too many doctors fail to get to know their patients as people.
“Patients can wind up wondering if the doctor really cares about them or if what is recommended applies to their unique situation and life experiences,” says Ziegelstein, a member of the Miller Coulson Academy of Clinical Excellence and the Sarah Miller Coulson and Frank L. Coulson, Jr. Professor of Medicine.
In the ensuing years since his original article on personomics, Ziegelstein’s clarion call has had an important impact at Johns Hopkins and beyond, inspiring many articles, essays, book chapters and presentations throughout the world. There is now even a special section in The American Journal of Medicine devoted to personomics that features articles on the importance of knowing the patient as a person in clinical care.
So has the dial been moved? When it comes to understanding the individual person beyond the disease, are patients and doctors better off today than they were a decade ago?
Those questions were key to the issues Ziegelstein addressed in May as the featured speaker of the 23rd annual Miller Lecture at Johns Hopkins. Launched in 2004, thanks to the generosity of Anne G. Miller and her family (Sarah Miller Coulson, Leslie A. Miller, and Richard Worley), the public lecture offers insights that go beyond the technical side of medicine to explore the human side of health care. Past speakers have included notable authors, musicians, artists and thought leaders, all who shared their valuable wisdom on medicine’s mission, the patient experience and humanistic aspects of healing.
“It’s a tremendous honor for me to be asked to deliver the Miller Lecture. I think of it as the Macy’s Thanksgiving Day parade — an exciting celebration of what’s important in medicine when it comes to taking care of patients better — of discussing what we’re doing right and where we need to do more.”
Reached in advance of the lecture, Ziegelstein expressed his belief that one part of what he describes as the “personomics equation” has gotten better since 2015.
“We are much more precise in our knowledge of medicine than we were 10 years ago,” he says. One indicator: the 1.5 million new scholarly articles published each year in PubMed, the online database maintained by the National Library of Medicine. “As a result, there are diseases that are treatable today that were not treatable 10 years ago. That is totally amazing,” he says.
The less heartening news, though, is that the other part of the equation — the opportunity for clinicians to get to know patients better as people — has gotten worse, he believes, and he cites a variety of burdensome barriers. These include the ever-growing requirements for electronic documentation, the pressure to squeeze more into shorter patient visits, and the time required to coordinate with other providers and insurance companies.
Further complicating the picture: While in the past, patients often maintained relationships with doctors over many years, that’s become much less common, Ziegelstein says. “It’s difficult to get to know a patient with just one visit. If you don’t have that relationship that is developed over time, then providing personalized care is much more challenging.”
“It’s difficult to get to know a patient with just one visit. If you don’t have that relationship that is developed over time, then providing personalized care is much more challenging.” – Roy Ziegelstein
But there is a silver lining. Ziegelstein actually finds hope in current technological innovation, specifically in artificial intelligence. He believes AI holds promise for relieving clinicians of more mundane tasks — such as record summarization, charting and routine patient communication — and will vastly improve and speed physician access to the best evidence-based medical information and clinical decision support.
“The other day I saw a patient for the first time who came in from a different health system. There were 330 pages of medical records for me to go through, which took several hours,” he says. AI will soon make it possible to digest a patient’s records in seconds, Ziegelstein says, and to access the “golden nuggets” from those 1.5 million articles published annually in PubMed. “I am optimistic that this will allow more time for clinicians to get to know their patients and provide high quality, actionable clinical insights, right at the point of care.”
