Jonathan Rosen, MD
As a family physician for over 37 years, Dr. Jonathan Rosen sees patients who range from age 1 to 100. As his patients age along with him, so does the complexity and intensity of treating them. While he puts particular value on forging long-term relationships with his patients, he says that has become more complicated in the current health care environment.
“Medicine has changed over these many decades that I’ve been caring for people,” he says. “Care is much more fragmented.”
This is especially true for older patients, who may struggle with multiple chronic conditions.
It certainly was the case for his patient Rita, an 83 year-old patient who presented with a host of medical issues including a fractured humerus, osteopenia, polymyalgia rheumatica, hypertension, hypothyroidism, esophageal reflux, autoimmune hepatitis, and constipation among several other conditions. She had also suffered depression following the deaths of both her husband and her son. Each of her conditions suggested a range of possible tests, likely medications, probable therapies and a long list of potential medical consultants.
Impact of a fragmented medical system on patients
It’s all part of the overall fragmentation that Dr. Rosen has seen in our health care system.“[Patients are] seeing a variety of specialists who come in and out of their lives and getting a bit tossed on the ocean,” Dr. Rosen says. Although specialist and primary care clinicians strive to find the best treatments for their patients, they are often not on the same page regarding what is most important to the patient. Dr. Rosen explains that “their individual needs, the individual priorities, how their care relates to their day-to-day existence often gets lost amidst this turmoil.”
“[Patients are] seeing a variety of specialists who come in and out of their lives and getting a bit tossed on the ocean,” Dr. Rosen says.
To bring calm to that kind of turmoil, Dr. Rosen counts on the Patient Priorities Care approach to help align care and treatments based on what is most important to patients.
After identifying her health priorities with a trained Patient Priorities Care facilitator in his practice, Rita was able to recognize and share that her greatest concern, her inability to sleep, was largely due to a general nighttime achiness. This was important information for Dr. Rosen, who, prior to the Patient Priorities Care approach, had attributed much of her sleep difficulty to urinary incontinence and back problems.
“This was generalized achiness, which I really did not appreciate was going on so much,” he says. “And that, I think, ultimately was specifically related to her rheumatism, her polymyalgia rheumatica. So I had to really explore that much more carefully after I realized that she was being so affected on a daily basis.”
Changes in his patient’s care
Knowing what matters most to Rita, and in conjunction with further testing, Dr. Rosen was able to prescribe medication for the rheumatism, remove an incontinence medication, and avoid other unwanted interventions.
Patients appreciate an approach which rallies the full team around their health outcome goals and the care and treatments they are willing and able to do. Dr. Rosen comments, “Before Patient Priorities Care was instituted with Rita and I understood what was important to her, I would have had her see multiple specialists and increased her treatments and healthcare tasks.” “I think that seeing 10…[medical practitioners]…in a month can drive everybody a little bit nuts”.
“The crux of why we care for patients is making sure that when we do things for them and to them, we’re doing it with their needs and their current function as a paramount goal…And Patient Priorities Care gives us that particular tool in a very well-designed and regimented way to seek out the patients’ needs and to implement changes in their care based on those needs.”
“My body was aching, but not anymore,” Rita says. “When I go to bed, it’s not aching anymore. I feel so much better.” Of her experience with Patient Priorities Care she says, “It’s made me feel 100% better.”
Dr. Rosen believes that this process helps improve care for older adults with many concurrent medical issues. “I think we empower our patients by enabling them with Patient Priorities Care to really speak out what’s most important to them at that moment, what’s paramount in their lives, what about their healthcare is intervening or interfering with their lifestyle, and what they’re getting out of their healthcare that’s most important. I think it’s a very empowering process.”
“Dr. Rosen cared about what mattered to me and helped because of it,” Rita says. “He’s my rock.”