Abstract
BackgroundGuidelines summarize medical evidence, they identify the most efficient therapy under study conditions and recommend this therapy for use. The physician now has the challenge to translate a therapy that is efficient under laboratory conditions to a patient who is an individual person. To accomplish this task the physician has to make sure that (I) the ideal typical therapy is applicable and effective in this individual patient taking the special features into consideration, that (II) therapy is compliant with the norm including guidelines, laws and ethical requirements (conformity) and that (III) the therapy meets the patient’s needs.ObjectiveHow can physicians together with the patients translate the medical evidence into an individually optimized therapy?Material and methodsAt the German Aortic Center in Hamburg we use I‑SWOT as an instrument to identify such individually optimized therapy. With I‑SWOT, we present an instrument with which we have developed an (I) efficient, (II) conform and (III) needs-oriented therapeutic strategy for individual patients.ResultsI-SWOT cross-tabulates strengths (S) and weaknesses (W) related to therapy with opportunities (O) and threats (T) related to individual patients. This I‑SWOT matrix identifies four fundamental types of strategy, which comprise “SO” maximizing strengths and opportunities, “WT” minimizing weaknesses and threats, “WO” minimizing weaknesses and maximizing opportunities and “ST” maximizing strengths and minimizing threats. We discuss the case of a patient with asymptomatic thoracoabdominal aneurysm to show how I‑SWOT is used to identify an individually optimized therapy strategy.
Highlights
Guidelines summarize medical evidence, they identify the most efficient therapy under study conditions and recommend this therapy for use
The physician has to make sure that (i) the ideal therapy is applicable and effective in this individual patient taking the special features into consideration, that (ii) therapy is compliant with the norm including guidelines, laws and ethical requirements and that (iii) the therapy meets the patient’s emotional and psychological needs
To accomplish this task the physician has to make sure that (I) the ideal typical therapy is applicable and effective in this individual patient taking the special features into consideration, that (II) therapy is compliant with the norm including guidelines, laws and ethical requirements and that (III) the therapy meets the patient’s needs
Summary
Guidelines summarize medical evidence, they identify the most efficient therapy under study conditions and recommend this therapy for use. Opportu- The characteristics of an individual patient, which are promotive for maximizing nities (O)a the success of therapy in a (i) physical (ii) normative and (iii) emotional dimension. Threats (T)a The characteristics of an individual patient, which are obstructive for maximizing the success of therapy in a (i) physical (ii) normative and (iii) emotional dimension aThese points are evaluated by the physician. Measured as the area of both triangles, therapy success in the three dimensions effectiveness, norm compliance and needs-oriented is greater in the individualized medical therapy (redtriangle) than in the evidence-based medicine uniform approach (blue triangle) size fits all way of doing standardized medicine irrespective of individuality; therapy that ignores the physical conditions of the individual patient risks technical treatment failure.
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