P4 Medicine

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P4Medicine (P4) clinics —a recognized brand

P4 Medicine Institute has been organized to encourage the creation of the best health and wellbeing possible for our collective futures. There are three major areas of emphasis: 1) proaction, rather than reaction, 2) whole person wellbeing rather than just the absence of illness and 3) social and community health–people do not thrive in isolation. It is a rethinking of the field of medicine, a rethinking of the purpose and goals, the methods and tools, as well as the participants.

The causes and cures of adverse health outcomes in the US fall into several categories:

  • Medical 10%
  • Behavioral 40%
  • Genetic 30%
  • Social 15%
  • Environmental 5%

We will keep each of these causes and cures in mind as we look at Prediction, Prevention, Personalization and Participation.


Current and past behaviors (medical history and risk assessment)

Psychological resilience and readiness for personal behavior change

Standard medical and biological screening

  1. Family history
  2. Past medical history
  3. Physical exam
  4. Imaging
  5. Laboratory
  6. Physical fitness assessment
  7. Psychological fitness assessment (Army Strong)

Advanced biological screening: Genetics, Epigenetics, and Proteomics

Wikipedia on Predictive Medicine.


Standard preventive health strategies to manage

  1. Diet
  2. Physical fitness
  3. Psychological fitness
  4. Economic risk
  5. Family and marital risk
  6. High risk behaviors
    • Substance abuse
    • Physical risk taking
    • Sexual risk taking
    • Relational risk taking

Genetic counseling

Monitoring for at risk conditions

Wikipedia article on Preventive Medicine.


  • Patient Activation Measure
  • Losada Ration
  • Losada ratio of family members

Wikipedia on Personalized Medicine.


Enhance Shared Care Plan

  1. Data base
  2. User interface
  3. Access to your genome and your family’s genome
  4. Access to your protein diagnostics
  5. Match your drugs to your genome and proteins
  6. Move Losada ratio concistently above 3.0
  7. Move PAM into level 3 or 4
  8. Make commitments and take action
  9. Monitor conveniently
  10. Coach to desired level performance
  11. Create social linkages for support enjoyment

Integrate P4M Clinics with ACC/ACOs in Whatcom, Lane, and Siusilaw

Integrate HIE technology with ACC/ACOs in Whatcom (WAHA), Clark (C.U.P.), Lane, and Siusilaw

Shared Care Plan, Transitions Coordinator, Direct Coordinator & Telehealth

Provide HIE Services at whole community level: HInet/MIN-NS/eHeatlhWorks

Support Behavior Change in P4M Clinics

  • Coaching (Navigator-coaches/care coordinators)
  • Shared care plan’s Care Manager Dashboard
  • Comprehensive Fitness Evaluation (from US Army)
  • Diet–Answers Media?
  • Fitness–Answers Media?
  • Psychological Resilience–retired Brigadier General Rhonda Cornum, MD; UPENN?; Answers Media?

Wikipedia on Participatory Medicine.