12:46am Monday 11 December 2017

By Focusing on Reducing Disease Risk, “Desktop Medicine” will Transform the Practice of Medicine

Gone are the days when a doctor’s only way of helping patients is by treating the disease after symptoms have started. Instead, a new approach to medicine, called “Desktop Medicine” is emerging, in which the emphasis shifts from diagnosing diseases and treating symptoms to identifying risk-factors for medical conditions such as hypertension and osteoporosis, and intervening before they develop. The commentary appears in the current issue of the Journal of the American Medical Association.

“Desktop medicine,” a model defined by Jason Karlawish, MD, Associate Professor of Medicine and Medical Ethics at the University of Pennsylvania School of Medicine, involves clinicians continuously gathering risk factor information – from a patient’s medical history, electronic medical records or recent office visit – and combining it with clinical studies about disease risk. Once the patient’s risk has been assessed, the physician can provide the appropriate intervention to prevent the onset of disease, rather than treat the disease once it is fully developed. 

“Desktop medicine has substantial implications for how we ought to educate, train, and practice medicine,” said Dr. Karlawish. “For example, medical training should teach how to help patients appreciate their relevant risks and manage these risks, as many patients fail to adhere to a long-term intervention intended to prevent disease.”

This new model may also explain why primary care is suffering. Physicians need to learn how to incorporate both bedside and desktop medicine into an office visit, so long-term disease prevention is not overlooked while a short-term symptom is being addressed, and vice versa. Transformations in medical practice, such as electronic medical records, are also essential.

Medical and pre-medical education focused on epidemiology, genomics, and information sciences are increasingly important. Electronic medical records are crucial, as physicians use statistical models that require large sample sizes to detect risk. Both physicians and patients, who have increasing access to their own medical information, will have to learn how to collaborate on the decision making process. In addition, as new techniques are developed to change patient behaviors – such as payments for adhering to medications – physicians will need to learn how to talk with patients about these financial incentives.

 

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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $3.6 billion enterprise. 

Penn’s School of Medicine is currently ranked #2 in U.S. News & World Report’s survey of research-oriented medical schools, and is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $367.2 million awarded in the 2008 fiscal year. 

Penn Medicine’s patient care facilities include:

  • The Hospital of the University of Pennsylvania – the nation’s first teaching hospital, recognized as one of the nation’s top 10 hospitals by U.S. News & World Report.
  • Penn Presbyterian Medical Center – named one of the top 100 hospitals for cardiovascular care by Thomson Reuters for six years.
  • Pennsylvania Hospital – the nation’s first hospital, founded in 1751, nationally recognized for excellence in orthopaedics, obstetrics & gynecology, and psychiatry & behavioral health. 

Additional patient care facilities and services include Penn Medicine at Rittenhouse, a Philadelphia campus offering inpatient rehabilitation and outpatient care in many specialties; as well as a primary care provider network; a faculty practice plan; home care and hospice services; and several multispecialty outpatient facilities across the Philadelphia region.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2009, Penn Medicine provided $733.5 million to benefit our community.


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