Jonathan Rosen, MD
Dr. Rosen’s Story: Designing Care Around a Patient’s Goals
I am facilitating the implementation of the Patient Priorities Care pilot program at ProHealth Physicians, a primary care network in Bristol, Connecticut. As Clinic Champion, my role is to interface between the Patient Priorities Care research team and our seven-physician clinic as we build evidence for the approach and identify how to best incorporate it into real-world workflows.
The goal of Patient Priorities Care embodies the essence of patient-centric medicine. Patients – especially the elderly with multiple medical problems, on multiple medications, and seeing a variety of specialists with often differing priorities – can become overwhelmed by the demands of their care. They can be confused and burdened by guidelines that may or may not pertain to their individual needs and desires.
As a first step in the Patient Priorities Care process, the patient meets with a goals facilitator for a candid conversation about their medical issues, their care plans, their medications, and their physician visits. But all of these things are discussed within an important context: how they relate to the patient’s overall life goals.
By leading with the patient’s goals, the patient’s care team can link in what way the patient’s medical care enables or hinders his or her own goals. The process promotes a dialogue between the patient and his or her primary care physician regarding what elements of their care should be modified based on those goals. Finally, these changes and priorities are communicated to and implemented by the patient’s specialists.
The most critical element of this type of care modification centers upon the initial conversation with the patient and their goals facilitator. Patients rarely look at their health and healthcare in totality, but instead are often passively tossed about in the system, taking medications, having procedures, and physician visits and engaging in care processes without understanding their impact or weighing costs versus benefits. This dialogue requires the patient to examine what elements of their care can help or hinder their own life goals. It also asks loved ones and caretakers to hear and understand the patient’s needs and desires. Finally, it allows the patient to both vent about and address what is often a feeling of helplessness in their ability to influence their medical care.
Ultimately by outlining and specifying what is most important to our patients, we will only be prescribing those medications and instituting those procedures that will further the patient’s goals and priorities. That focus cannot help but decrease the care burden on the individual and the monetary and human stress to the entire medical system.