Ricki Lewis

Mar 07, 2016 12:09 PM EST

I empathize - medicine seems far more schizophrenic than ever, where advances indicate a "Brave New World" of astonishing cures, soon to come, yet daily interactions with the health care realities suggest the norm is perfunctory, complacent, and generic, if not outright incompetent. I just found it even worse after entering the Medicare maze; the last concerned, attentive personal physician I had was in high school. One is more likely to be overmedicated, yet underdiagnosed, so being cured by any of the new methods you discuss is remote, overall.

- Ela

Mar 07, 2016 12:56 PM EST

Yes Ela, I agree. A sad situation. Thanks for reading my posts, but it's probably better to do so at http://blogs.plos.org/dnascience/ I fall behind in re-posting here. Nice to meet you! I'm a few years away from Medicare but am nervous about it already. I hate when health care providers spent 5 minutes with you and do not listen.

- Ricki Lewis

Nov 29, 2011 7:24 PM EST

What a horror that these poor parents have to gonthrough just to get their child's problems diagnosed. They deserve medals for love and persevere ce

- Wendy

Dec 06, 2011 7:35 AM EST

Thank you, Ricki, for eloquently capturing the last few years. :)

- Jen (Gavin's mommy)

Jul 26, 2014 11:08 PM EDT

This ia a good example of how out of touch MDs are with reality and how little they are taught in school. Medical schools must make genetics a big part of teaching medical doctors. Genetics has only started to dramatically change everything and will force the government to very soon switch to medicare for all. At the present time medical doctors are the slaves of the insurance corporations. Very soon doctors will type into their computer connected to a government website and read the genome and everything about a patient before they meet the patient waiting in the outer room.

- James L. Atwell

Jul 27, 2014 6:21 AM EDT

Thanks for your comment! I agree. This post is a few years old, and finally health care professionals are beginning to learn more genetics and genomics. The new edition of my human genetics is focused on these folks -- hope it helps!

- Ricki Lewis

Oct 14, 2011 11:43 AM EDT

I think many of us in the field (of genetic counseling) have been waiting for the day of whole genome sequencing at a reasonable price. While it might not make sense for someone who is healthy and at population risk for cancer and other diseases, those that come for genetic counseling often have significant histories of early onset and often multisystem disease. It is no small feat to organize single gene genetic testing, given insurance constraints, and ever growing costs for co-payments and high deductibles. Any patient who tests negative or normal on the first run of testing then enters the world of follow-up genetic testing which is a confusing world of testing for genes of lower penetrance, variable onset, and uncertain significance. Not to mention the fact that such testing is often not readily covered by insurance. It makes more sense to opt for a test that is much more likely to offer an answer to the broad question of genetic risk which is what exome sequencing. Exome sequencing on a population level might be like looking for a needle in the haystack, but for the patients that I see for genetic counseling, if would be like looking for your cellphone in the haystack. Much easier to find when you know what you are looking for. I do think most patients would want to take advantage of whatever testing their insurances would cover first, but whole exome sequencing should be a consideration immediately afterwards, if initial testing provides no information.

- S. Bonnie Liebers

Oct 14, 2011 12:53 PM EDT

Thanks, Bonnie. I'm at the International Congress of Human Genetics right now, and exome sequencing is just around the corner. Much discussion has focused on the problem of what to do about incidentalomas -- when to report increased risks, and how to determine what degree of risk is sufficient to inform the patient? One thing is certain -- there aren't enough genetic counselors to handle a population that accepts whole exome sequencing.

- Ricki Lewis