Health knowledge made personal
 After a week from hell I am back. I am sad that I missed a week's worth of cancer genetics patients, but they wouldn't have found me very useful at the time! As I recover, I wanted to point you in the direction of 2 articles which quote This lovely blog, Gene Sherpas!Yes that's right, peer reviewed journal articles quoting the Sherpa....ok, wellone was an article I wrote,so I guess that doesn't count! ButLi Hui Xuat the great Ohio State University College of Medicine's Center for Personalized Healthcarequotes me....I have to tell ya, I was flattered! "Steven Murphy, the blogger of the Gene Sherpa and Clinical Genetics fellow at Yale University (CT,USA) advises institutions to abandon the 'prize' for publication, which is so highly valued in academia, but prevents the early exchange of information and resources. Instead, Murphy says, institutions needs to nurture inter-institutional collaboration " In fact, I would say we should prize how many universities were involved in every study!"" Wow! Thank you for reading this blog. I am honored to have it quoted in a peer reviewed journal such as Personalized Medicine! I know the weekend is coming up. But I will be working on a presentation I am going to give at the NSGC. The topic, where do genetic counselors fit in personalized healthcare. Here's a sneak peek. 1. Genetic counselors: are trained in genetic counseling and have 2 years post-baccaluareate training. They take their certification exam once and Never Again! Did I mention that they don't dose medications, take pharmacology, or study anatomy or pathology (Basic medical science)? They do have one or 2 courses in clinical medicine where they "discuss medicine in a workshop format" They do take family and medical histories though. I have even seen a few try to do physical exams, even though they were never formally instructed in this. They do require Continuing education though, which is very nice. All in all that is ZERO years of clinical training prior to running their own genetic counseling division under the loose supervision of a doctor or doing SNP scan counseling. They do have to have 50 cases though.....Number? Approximately 2000 or so. 2. Nurse practitioners: are trained in clinical nursing and have had 2 years of post baccalaureate training. But first had attained 4 year degrees in a clinical setting (i.e. dosing medications, caring for patients). In addition, they too have a certification exam which they do not need to recertify. But in addition, require continuing education. Plus did I mention that they also did 4 years of clinical training PRIOR to their master's degree? NPs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and write prescriptions too. All in all that is 4-6 years of clinical training prior to being under the supervision of a doctor. A little more than 50 cases I imagine. Number 120,000 3. Physicians' Assistants: are trained in a 4 year bachelors degree and then go on to 2 years of intense basic medical science and clinical training. When they are done PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and write prescriptions. They also are required to recertify every 6 years and take CMEs too. Most PA programs even require some sort of healthcare experience prior to going to PA school. All in all that is 2 years of clinical training prior to being under the supervision of a doctor. Still more than 50 cases......Number? 43,000 or so 4. Medical Geneticist: Take 4 years of bachelors, often in basic medical science. Then go on to 4 years of medical school. Then they go on to 3 years (at least) of medical residency where the diagnose, treat, dose medications, perform physical exams, take calls. AND THEN they go on to 2 more years of training in fellowship, diagnosing and treating genetic medical disease, doing research, taking calls. All in all that is 9 years of clinical training under their belts prior to being on their own. Plus they have 150 cases and that pesky 9 years of training. Number? 700 or so. Why do I mention this? Because the public needs to know what they are getting with each type of consultation. And I do this to make the point that Certified Genetic Counselors will struggle to find their place in Genomic Medicine, unless they go back and truly train in clinical medicine. The genomic nurse's are clamoring to take your positions. They don't even speak the clinical language very well. In order to take accurate medical and family histories, they need to know the genetic implications of sudden death, stroke, heart attack, coumadin metabolism, protonix efficacy, alzheimer's disease, COPD, I coudl go on and on. But if they never saw it and talked about it, how could we ever ask them to learn this stuff through Osmosis or "Clinical Workshop"????? To be a part of the team in Genomic Medicine, a counselor needs to decide, do I want to be a licensed healthcare practitioner? Or an educator for them? If the answer is the former, I humbly suggest 2 years of clinical education. If the answer is the latter, I would not give medical advice/education without having it ok'd by my supervising physician. Because if you were scratching my signature on that insurance form illegally, I would be damn sure you were giving proper medical advice. Warning This is an Extreme example of genetic counselors left unsupervised! Not all counselors are like this. Just the overconfident ones are! Why do I say this? Because, I have seen CGCs tell patients that if they have their ovaries out prior to menopause that it is ok to take hormone replacement therapy. But NEVER, EVER tell them the risks of HRT, including stroke!!!! In fact, I saw a CGC take a family history loaded with stroke, yet tell the patient straight faced she could go on HRT. When I questioned her where she heard that, she said: "Well, or lead counselor has some papers on it." I told her that I was taught,WHI was stopped b/c the Estrogen Alone Arm increased risk for stroke compared to placebo....she said, well I have a compilation I can give you. What she pulled out was garbage. It was a piece of paper explaining how HRT in premenopausal BRCA carriers don't have increased risk of getting breast cancer......There was nothing about stroke in it at all. This is the type of thing that doesn't surprise me. Did a CGC ever learn about stroke? NO. Did they ever learn about sticky platelets in the face of estrogen? NO. Did they ever learn about platelet glycoprotein receptors? Likely Not? So why would I expect them to counsel on the risk of HRT? They don't speak the language. This is precisely why they need to be under the direct supervision of physicians. But that's not what's happening. Ask any Cancer counselor and they will tell you about the tremendous amount of insurance fraud that is going on...if they dare.... But I am here to tell you about the tremendous amount of significant medical misinformation that is being conveyed to the detriment of the patient. It is sad and must stop. No offense to my excellent CGC colleagues who recognize their limitations. But to the rest of you, stop practicing medicine or I will expose you. So to answer the question, where do CGCs fit in? As the informer of disease risk for diseases they are trained to understand and know, and not to give medical/medicinal advice unsupervised, EVER! That being said, you can learn about a field you weren't trained in, but you should stick with the doctor, or physician approved guidance. Some counselors will learn more than others, but they still should have physician supervision........If you want to do more......go back to school......... The Sherpa Says: These are harsh words. I think CGCs are fantastic as a whole. But we have to be realistic, we could do much better training just 3 percent of the NPs or 5 percent of the PAs and be able to carry out Genomic Medicine efficiently. It would take 100 percent of CGCs to go back to school for 2 years to carry this out. It is just not reasonable to expect them to do that......plain and simple. To all my CGC friends, I still love you. I hope you aren't pissed at me. If you are, then send me an email. I am sure this will make the SIG. |
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