We developed Patient Priorities Care to address the uncertain benefits and burdens of healthcare faced by many older adults with multiple conditions. This approach, which involves identifying and aligning healthcare around patients’ specific health priorities, is associated with reduced perceived treatment burden, more wanted and less unwanted care, with perhaps a modest reduction in ED and hospital visits without adverse effects on disease-based quality metrics.

Despite these benefits, we struggle with how to frame what we do in ways that are understandable to patients, care partners, health professionals, and health systems.

How do we respond to patients who feel:

“Doctors know what I need. They know more than me. Who am I to tell them what to do?” Or others who think, “I know what I need. It bothers me that doctors think they know best.”

How do we address skeptical clinicians:

“Most older people don’t want to be involved in decision-making. It’s too complicated.” “They’ll ask for things that won’t help.” Or at the other extreme, “I am here to do what my patients want. I already do that.”

The answer came as I worried about funding my retirement. I reached out to my financial advisor. Like many people, I am easily overwhelmed by financial planning and all the jargon. I wanted, and expected him, to tell me what to do. But, he didn’t.

He asked me questions like: “What matters most to you? What do you worry about the most?” “Is what happens over the next few years most important, or do you focus on being in good shape in 2-3 decades?” (My father lived to 100.) “What do you want to do with your money? What brings you joy?” “Are you willing to risk a bad outcome to have a chance at a really good outcome, or do you want to play it safer, not risk too much over the short run but not ignore the long run either?”

I was surprised, and frankly a bit frustrated, by all these questions. However, I dutifully answered them the best I could. We discussed pros and cons, then worked through a plan that felt right. I realized this wouldn’t have happened had I not taken the time to reflect on what mattered most and he hadn’t focused his recommendations on my financial priorities.

A person-centered financial advisor is a good analogy for patient-priorities focused health professionals. I am the expert in the retirement outcomes most important to me while my financial advisor is the expert in how financial planning can help me achieve these outcomes given my risk preferences.

Similarly, patients are the experts in what matters most about their health and healthcare while health professionals are the experts in estimating, from the wide panoply of available health care, the treatment choices most likely to achieve each person’s health goals given their care preferences.