May 29, 2026 · 29 min · 14 segments
What is precision medicine, and how should precision medicine be handled in the face of guidelines and protocols? In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Diane C…
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Michael R. PinskyGuestDiane McLaughlinHostIt feels like we have all of these buzz terms that are coming around, and when you-- I first heard precision medicine, to me, that seemed a little bit obvious.
Isn't everything that we're trying to do to help somebody supposed to be somewhat precise? What is precision medicine, and how do we use the tools we have to achieve that?
You said that you think that everything we do is precise, and that's absolutely not true.
The original Surviving Sepsis guidelines had this ridiculous statement that you had to give thirty mls per kilogram to every patient.
Your circulating blood volume is forty-five milligrams per kilogram-- mls per kilogram.
So you're basically giving two-thirds of the blood volume right back to a person.
Okay? And number two, you're treating vasoplegia in sepsis, which is increasing unstressed volume.
Yes, they need some fluids, but you want to restore the normal vasomotor tone, and if you just give fluids to do it, I assure you you'll get volume overload.
So to start with the first statement, there's a lot of things we do that are not precise.
As your colleague said, who knew me when he was a fellow, not only do I love to teach at the bedside because you're teaching on a specific patient to treat that patient specifically, but you're looking at the same time at their response to therapy.
I'm not so arrogant as to tell you what the patient's going to do, but I am observant enough to watch how they respond, and if I realize I've done the wrong thing, to stop it.
It's the titration of care, and I give as an analogy a person driving a car.
And if all you saw were the person's hands on the wheel and feet on the brakes and the gas, you'd say, "What is this person doing? They're stepping on the gas.
All I told them was I want to go from here to school, and they're changing everything." And the person looks at you and they say, "Every second the condition we're dealing is changing, and I have to adapt to it or we're gonna have a car accident." That is no different than a patient.
It feels like we have all of these buzz terms that are coming around, and when you-- I first heard precision medicine, to me, that seemed a little bit obvious.
Isn't everything that we're trying to do to help somebody supposed to be somewhat precise? What is precision medicine, and how do we use the tools we have to achieve that?
You said that you think that everything we do is precise, and that's absolutely not true.
The original Surviving Sepsis guidelines had this ridiculous statement that you had to give thirty mls per kilogram to every patient.
Your circulating blood volume is forty-five milligrams per kilogram-- mls per kilogram.
So you're basically giving two-thirds of the blood volume right back to a person.
Okay? And number two, you're treating vasoplegia in sepsis, which is increasing unstressed volume.
Yes, they need some fluids, but you want to restore the normal vasomotor tone, and if you just give fluids to do it, I assure you you'll get volume overload.
So to start with the first statement, there's a lot of things we do that are not precise.
As your colleague said, who knew me when he was a fellow, not only do I love to teach at the bedside because you're teaching on a specific patient to treat that patient specifically, but you're looking at the same time at their response to therapy.
I'm not so arrogant as to tell you what the patient's going to do, but I am observant enough to watch how they respond, and if I realize I've done the wrong thing, to stop it.
It's the titration of care, and I give as an analogy a person driving a car.
And if all you saw were the person's hands on the wheel and feet on the brakes and the gas, you'd say, "What is this person doing? They're stepping on the gas.
All I told them was I want to go from here to school, and they're changing everything." And the person looks at you and they say, "Every second the condition we're dealing is changing, and I have to adapt to it or we're gonna have a car accident." That is no different than a patient.
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