Jeffrey Goldberg, MD
Dr. Jeffrey Goldberg has been practicing family medicine for over 24 years, and for him it’s the “family” in family medicine that makes it all worthwhile. He has had the responsibility–and pleasure–of caring for his patients over decades. “I really enjoy the continuity, seeing people and families grow up… that’s what I am all about,” he says.
Still, the challenges can be formidable. He recounts: “I often tell the students I teach that medicine is a losing proposition.” No one can fend off illness forever, particularly his older patients, many of whom present with multiple medical conditions.
For example, Dr. Goldberg was aware that one of his patients was taking a combination of 19 medications, including three drugs for diabetes, three for hypertension, and others for hyperlipidemia, esophageal reflux, peripheral neuropathy, allergy, as well as inhalers for asthma. He sensed his patient was becoming anxious and depressed by having to deal with so much medication, some of which she believed was not helpful and possibly harmful.
He sensed his patient was becoming anxious and depressed by having to deal with so much medication…
A useful tool in his medical toolkit
Dr. Goldberg turned to the Patient Priorities Care approach (PPC), which his practice had just begun implementing, in order to obtain a clearer understanding of patients’ health goals based on values and care preferences, and what matters most to them.
Through a series questions designed to elicit reliable and actionable health outcome goals and care preferences, Patient Priorities Care helps Dr. Goldberg get to the heart of how best to serve his older patients with multiple medical conditions by aligning their current care and treatments to help them do more of what matters most.
Dr. Goldberg was able to learn that his patient’s diabetes medications were causing her so much distress that she had stopped taking them of her own volition.
“She was on three diabetes medications,” he recounts, adding that one of her specialists was adding even more medications.
Changes in decision-making around healthcare
Seeing that the patient’s diabetes was well controlled, and sharing her specific health priorities with the other clinicians involved in the patient’s care, Dr. Goldberg was able to negotiate a compromise with the specialist who was in favor of more aggressive medication. Dr. Goldberg and the specialist agreed to reduce one of the diabetes medications on a trial basis, and in so doing, reduce the frequency of the need for blood sugar testing.
This reduction in blood sugar testing made a significant, tangible improvement in the patient’s daily experience. Feeling her empowerment in her health care decisions, the patient in turn became much more of an active participant in other aspects her health care.
Had the Patient Priorities Care approach not been used, the patient would likely have continued taking matters into her own hands in risky ways, like not adhering to her medication regime, or ended up more depressed and frustrated by her medications and blood sugar testing.
Instead, the patient experienced a positive change in body and spirit, despite the number of serious health problems she has.
Dr. Goldberg feels strongly about the benefits of this new approach, “Patient Priorities Care really kind of gets into what is important about their medical care for them, why they care about being healthy, why they want to take care of themselves…..[It]…really individualizes that and enables us to see them as a person and focus on what’s important to them….they are the ultimate decision maker”.