Bio

Bio


Dr. Pakdaman practices Internal Medicine and is the Medical Director of Stanford Concierge Medicine and Stanford Executive Health. 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 both Executive Medicine as well as premier Concierge 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. In addition, Dr. Pakdaman was the chair of the El Camino Hospital Ethics Committee in 2009 and served as an advisory member on the board of the Genomics Medicine Institute at El Camino Hospital. Drawing from her experiences working in both executive health programs and premiere retainer based practices, she joined Stanford in 2012 to help launch Stanford Concierge Medicine.

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
  • chronic dise
  • preventive medicine

Academic Appointments


Administrative Appointments


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

Honors & Awards


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

Boards, Advisory Committees, Professional Organizations


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

Professional Education


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

Publications

Journal Articles


  • 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

  • Clinical Interpretation and Implications of Whole-Genome Sequencing JAMA-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): 1035-1044
  • 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

Conference Proceedings


  • 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

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