Bio

Bio


Dr. Pakdaman practices Internal Medicine in Silicon Valley. She received her medical education at Yale University School of Medicine where she earned the Janet M. Glasgow Memorial Achievement Award for Women in Medicine. She completed her residency in Internal Medicine at Stanford University Hospital and was nominated for the Alwin Rambar-James Mark Award for Excellence in Patient Care.

Dr. Pakdaman has been involved in developing innovative models for patient centered practice delivery. She has extensive background in Concierge Medicine as well as Executive Medicine. In addition, prior to coming to Stanford, she helped initiate and served as medical director for the Palliative Care inpatient consult service at El Camino Hospital. During that time, she served as chair of the El Camino Hospital Ethics Committee and as an advisory member for the Genomics Medicine Institute at El Camino Hospital. Drawing from her experiences working in both executive health programs and retainer based practices, she joined Stanford in 2012 to help launch Stanford Concierge Medicine. She subsequently served as the Medical Director of Stanford Concierge Medicine and Stanford Executive Health for five years where she helped pilot aspects of Stanford Precision Health platform.

Dr. Pakdaman's clinical focus is adult primary care with health promotion and disease prevention/management.

Board Certified Internal Medicine 2003, 2013
Board Certified Hospice and Palliative Medicine 2008

Clinical Focus


  • Internal Medicine
  • health promotion
  • wellness
  • preventive medicine
  • chronic disease

Administrative Appointments


  • Adjunct Clinical Faculty, Stanford School of Medicine (2003 - 2012)
  • Clinical Assistant Professor, Stanford School of Medicine (2012 - Present)
  • Medical Director, Stanford Concierge Medicine and Stanford Executive Medicine (2013 - Present)

Honors & Awards


  • Phi Beta Kappa, University of California, Santa Cruz (1995)
  • Janet M. Glasgow Memoria Award for Achievement for Women in Medicine, Yale Medical School (2000)

Boards, Advisory Committees, Professional Organizations


  • Member, American College of Physicians (2003 - Present)
  • Member, American Academy of Hospice and Palliative Medicine (2007 - Present)

Professional Education


  • Residency:Stanford University School of Medicine Registrar (2003) CA
  • Internship:Stanford University School of Medicine Registrar (2001) CA
  • Medical Education:Yale School Of Medicine Office of Student Affairs (2000) CT
  • Board Certification: Hospice and Palliative Medicine, American Board of Internal Medicine (2008)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2003)
  • BA, University of California, Santa Cruz, Biology (1995)

Publications

All Publications


  • Patient and provider perspectives on the development of personalized medicine: a mixed-methods approach. Journal of community genetics Puryear, L., Downs, N., Nevedal, A., Lewis, E. T., Ormond, K. E., Bregendahl, M., Suarez, C. J., David, S. P., Charlap, S., Chu, I., Asch, S. M., Pakdaman, N., Chang, S. I., Cullen, M. R., Palaniappan, L. 2017

    Abstract

    While genetic testing gains adoption in specialty services such as oncology, neurology, and cardiology, use of genetic and genomic testing has yet to be adopted as widely in primary care. The purpose of this study is to identify and compare patient and primary care provider (PCP) expectations of genetics services in primary care. Patient and PCP perspectives were assessed through a mixed-method approach combining an online survey and semi-structured interviews in a primary care department of a large academic medical institution. A convenience sample of 100 adult primary care patients and 26 PCPs was gathered. The survey and interview questions focused on perceptions of genetic testing, experience with genetic testing, and expectations of genetic services in primary care. Patients felt that their PCP was knowledgeable about genetic testing and expected their PCP to be the first to recognize a need for genetic testing based on family history. Nonetheless, patients reported that PCPs rarely used family history information to discuss genetic risks or order testing. In contrast, PCPs felt uncertain about the clinical utility and scientific value of genetic testing. PCPs were concerned that genetic testing could cause anxiety, frustration, discrimination, and reduced insurability, and that there was unequal access to testing. PCPs described themselves as being "gatekeepers" to genetic testing but did not feel confident or have the desire to become experts in genetic testing. However, PCPs were open to increasing their working knowledge of genetic testing. Within this academic medical center, there is a gap between what patients expect and what primary care providers feel they are adequately prepared to provide in terms of genetic testing services.

    View details for DOI 10.1007/s12687-017-0349-x

    View details for PubMedID 29280052

  • Clinical interpretation and implications of whole-genome sequencing. JAMA Dewey, F. E., Grove, M. E., Pan, C., Goldstein, B. A., Bernstein, J. A., Chaib, H., Merker, J. D., Goldfeder, R. L., Enns, G. M., David, S. P., Pakdaman, N., Ormond, K. E., Caleshu, C., Kingham, K., Klein, T. E., Whirl-Carrillo, M., Sakamoto, K., Wheeler, M. T., Butte, A. J., Ford, J. M., Boxer, L., Ioannidis, J. P., Yeung, A. C., Altman, R. B., Assimes, T. L., Snyder, M., Ashley, E. A., Quertermous, T. 2014; 311 (10): 1035-1045

    Abstract

    Whole-genome sequencing (WGS) is increasingly applied in clinical medicine and is expected to uncover clinically significant findings regardless of sequencing indication.To examine coverage and concordance of clinically relevant genetic variation provided by WGS technologies; to quantitate inherited disease risk and pharmacogenomic findings in WGS data and resources required for their discovery and interpretation; and to evaluate clinical action prompted by WGS findings.An exploratory study of 12 adult participants recruited at Stanford University Medical Center who underwent WGS between November 2011 and March 2012. A multidisciplinary team reviewed all potentially reportable genetic findings. Five physicians proposed initial clinical follow-up based on the genetic findings.Genome coverage and sequencing platform concordance in different categories of genetic disease risk, person-hours spent curating candidate disease-risk variants, interpretation agreement between trained curators and disease genetics databases, burden of inherited disease risk and pharmacogenomic findings, and burden and interrater agreement of proposed clinical follow-up.Depending on sequencing platform, 10% to 19% of inherited disease genes were not covered to accepted standards for single nucleotide variant discovery. Genotype concordance was high for previously described single nucleotide genetic variants (99%-100%) but low for small insertion/deletion variants (53%-59%). Curation of 90 to 127 genetic variants in each participant required a median of 54 minutes (range, 5-223 minutes) per genetic variant, resulted in moderate classification agreement between professionals (Gross κ, 0.52; 95% CI, 0.40-0.64), and reclassified 69% of genetic variants cataloged as disease causing in mutation databases to variants of uncertain or lesser significance. Two to 6 personal disease-risk findings were discovered in each participant, including 1 frameshift deletion in the BRCA1 gene implicated in hereditary breast and ovarian cancer. Physician review of sequencing findings prompted consideration of a median of 1 to 3 initial diagnostic tests and referrals per participant, with fair interrater agreement about the suitability of WGS findings for clinical follow-up (Fleiss κ, 0.24; P < 001).In this exploratory study of 12 volunteer adults, the use of WGS was associated with incomplete coverage of inherited disease genes, low reproducibility of detection of genetic variation with the highest potential clinical effects, and uncertainty about clinically reportable findings. In certain cases, WGS will identify clinically actionable genetic variants warranting early medical intervention. These issues should be considered when determining the role of WGS in clinical medicine.

    View details for DOI 10.1001/jama.2014.1717

    View details for PubMedID 24618965

    View details for PubMedCentralID PMC4119063

  • Clinical interpretation and implications of whole-genome sequencing. JAMA : the journal of the American Medical Association Dewey, F. E., Grove, M. E., Pan, C., Goldstein, B. A., Bernstein, J. A., Chaib, H., Merker, J. D., Goldfeder, R. L., Enns, G. M., David, S. P., Pakdaman, N., Ormond, K. E., Caleshu, C., Kingham, K., Klein, T. E., Whirl-Carrillo, M., Sakamoto, K., Wheeler, M. T., Butte, A. J., Ford, J. M., Boxer, L., Ioannidis, J. P., Yeung, A. C., Altman, R. B., Assimes, T. L., Snyder, M., Ashley, E. A., Quertermous, T. 2014; 311 (10): 1035-1045

    Abstract

    Whole-genome sequencing (WGS) is increasingly applied in clinical medicine and is expected to uncover clinically significant findings regardless of sequencing indication.To examine coverage and concordance of clinically relevant genetic variation provided by WGS technologies; to quantitate inherited disease risk and pharmacogenomic findings in WGS data and resources required for their discovery and interpretation; and to evaluate clinical action prompted by WGS findings.An exploratory study of 12 adult participants recruited at Stanford University Medical Center who underwent WGS between November 2011 and March 2012. A multidisciplinary team reviewed all potentially reportable genetic findings. Five physicians proposed initial clinical follow-up based on the genetic findings.Genome coverage and sequencing platform concordance in different categories of genetic disease risk, person-hours spent curating candidate disease-risk variants, interpretation agreement between trained curators and disease genetics databases, burden of inherited disease risk and pharmacogenomic findings, and burden and interrater agreement of proposed clinical follow-up.Depending on sequencing platform, 10% to 19% of inherited disease genes were not covered to accepted standards for single nucleotide variant discovery. Genotype concordance was high for previously described single nucleotide genetic variants (99%-100%) but low for small insertion/deletion variants (53%-59%). Curation of 90 to 127 genetic variants in each participant required a median of 54 minutes (range, 5-223 minutes) per genetic variant, resulted in moderate classification agreement between professionals (Gross κ, 0.52; 95% CI, 0.40-0.64), and reclassified 69% of genetic variants cataloged as disease causing in mutation databases to variants of uncertain or lesser significance. Two to 6 personal disease-risk findings were discovered in each participant, including 1 frameshift deletion in the BRCA1 gene implicated in hereditary breast and ovarian cancer. Physician review of sequencing findings prompted consideration of a median of 1 to 3 initial diagnostic tests and referrals per participant, with fair interrater agreement about the suitability of WGS findings for clinical follow-up (Fleiss κ, 0.24; P < 001).In this exploratory study of 12 volunteer adults, the use of WGS was associated with incomplete coverage of inherited disease genes, low reproducibility of detection of genetic variation with the highest potential clinical effects, and uncertainty about clinically reportable findings. In certain cases, WGS will identify clinically actionable genetic variants warranting early medical intervention. These issues should be considered when determining the role of WGS in clinical medicine.

    View details for DOI 10.1001/jama.2014.1717

    View details for PubMedID 24618965

    View details for PubMedCentralID PMC4119063

  • Effective Use of Lidocaine Infusion in the Home Hospice Setting 17th Annual International Palliative Care Conference Pakdaman, N. N., Brown, E., Ferraresi, V., Egan, B. 2008
  • Pyoderma gangrenosum and myelodysplastic syndrome SOUTHERN MEDICAL JOURNAL Litvak, D., Kirsner, R. S., Pakdaman, N. N., Federman, D. G. 2000; 93 (9): 923-925

    Abstract

    Pyoderma gangrenosum (PG) is a painful, often rapidly progressive, ulcerating skin disorder frequently associated with systemic diseases. We report the case of a patient with PG and an anemia. A bone marrow biopsy showed changes consistent with one of the myelodysplastic syndromes, refractory anemia with ringed sideroblasts. Patients with PG and anemia should have bone marrow biopsy if no cause of anemia is readily apparent.

    View details for Web of Science ID 000089274800019

    View details for PubMedID 11005358