As a Health Priorities Facilitator as part of the Patient Priorities Care pilot program at ProHealth Physicians, I help patients identify their health goals and care preferences, or what they are willing and able to do – as well as those things that they are not willing to do –  to achieve their desired outcomes.

I talk with each patient about what matters most to them—their values—to gain a deeper understanding of their priorities. In the initial session, I try to learn as much as I can about a patient’s specific medications, visits, and any self-care tasks that they do. The patient and I also discuss the tradeoffs associated with their health goals and care preferences. Tradeoffs can happen when a patient’s goals and preferences don’t align, or when the care for one condition might get in the way of another condition.

After coming to an agreement of what’s most important to the patient, I then share all of this information with their primary care provider so that they can talk about it at their next visit and re-align clinical care. I write detailed notes explaining what matters most to the patient and what they are willing and able to do to achieve their goals. This becomes a part of their medical record—a way for their primary care provider to see this snapshot in time and make clinical care changes. If they see a specialist, their health priorities document travels with them. I also work with their primary care provider on a weekly basis—we catch up on anything urgent right away, and I check in to see how their follow-up visits went.

I’ll always remember my very first patient – I’ll call her “Marjorie”. She was in her 70s, widowed, a heavy smoker with severe Chronic Obstructive Pulmonary Disease (COPD), and needed home oxygen. Like so many older adults, what mattered most to Marjorie was being able to retain her independence and leave her apartment. We talked a lot about the tradeoffs related to her smoking, her ability to walk without developing shortness of breath, and using her medications and her oxygen.

After I visited Marjorie a couple of times, I discovered that she was more willing to try using her daily inhalers and her oxygen if it meant she could help out with housework in the apartment she shares with her daughter. Her primary care physician and I talked about her readiness to use her prescribed medications more effectively. With the support of her daughter, Marjorie even made an attempt to quit smoking. I was able to connect her to the helpline for counseling and other resources specific to smoking cessation. She’s still working toward achieving that goal. All of my talks with Marjorie allowed me to coordinate with her and her clinicians to find the right combination of treatment and lifestyle changes to accommodate her priorities.

Most of my patients set goals similar to Marjorie. They wish to maintain self-sufficiency in their home, be able to walk upstairs, or go to the grocery store. Others may strive to stay connected and visit the senior center, go out to lunch with friends, or visit family members.

All patients are different, of course, but I think everyone can respond to the Patient Priorities Care approach because it’s based on what’s important to them.