Patients' goals key to effective care

There are critical questions missing when many physicians interview patients, according to an article in the Washington Post by family physician Mitch Kaminski, M.D. They are: "What are your goals for your care?" and "How can I help you?" he wrote.

In the piece, Kaminski recounted his experience with an 88-year-old patient suffering from both congestive heart failure and renal failure, who had endured continual medication adjustments and hospitalizations as the treatments for one condition would make the other worse. The frail patient wasn't interested in hemodialysis, which would break the cycle, for reasons the doctor understood.

When asked finally about his personal goals for care, the patient's response surprised the doctor. "I would like to be able to walk without falling," the patient said. "Falling is horrible." And unlike the progressive problems with his kidneys and heart, Kaminski noted, physical therapy could reduce the fall risk, which he ordered.

Beyond this immediate need, Kaminski, who was not the patient's regular physician, learned that the patient wanted to live out his final chapter at home and in comfort--a common desire among those near the end of life that rarely comes to fruition. In this case, hospice services fulfilled the patient's wishes.

A provider's respect for patient priorities is essential at all stages of life, noted Craig M. Wax, D.O., a family physician in New Jersey, in the context of motivational interviewing regarding lifestyle issues. He cited an example of a visit with a patient who had hypertension, high cholesterol and smoked two packs a day, but arrived at the office because he had an ingrown toenail. "Of course I wanted to address his hypertension, hyperlipidemia, smoking habits and lack of preventive care over the last five years; but he just wanted to deal with his toenail," Wax said. "And if I didn't deal with his toenail first, none of the other stuff would be on the table."

To learn more:
- read the article