Every patient visit starts with me trying to get one piece of information: the patient's goals. The method isn't complicated — I ask them what they want and hope to achieve, and I make that the target to hit. Patients deserve the best and most advanced care medicine has to offer. They also deserve care that's in accordance with their specific goals. We assume those are the same thing. They're often not.
Most patients, in my experience, don't truly know what their goals are until we talk about it — because receiving the most advanced care available is rarely the goal itself. Feeling better. Taking fewer medications. Needing fewer tests. An improved state of health and quality of life — sometimes even valued over quantity of life. That's usually the actual goal.
Most patients also don't have much choice in how they access healthcare in the first place. In most cases, they didn't come to see me because I offer the most novel or advanced approach, or use the most cutting-edge technology. They came because of what their insurance covers, their finances, their proximity, and the other constraints that determine who they can realistically see. Medicine, for good reason, generally focuses on guideline-directed "best practice" care, because it's been shown through science to improve outcomes and, sometimes, cost-effectiveness. But that focus doesn't always consider or achieve a patient's actual goals — which are often quite different from guideline-consistent treatment.
In my experience, achieving the best outcome for a specific patient means balancing statistical medical outcomes and guideline recommendations against something guidelines don't measure: how they feel day to day, how expensive it is to feel better once you count the cost of medications and procedures, how much time treatment takes away from a regular life, and what a patient sacrifices to pursue a course of treatment — missing a grandchild's high school graduation, say, for an ablation to treat an arrhythmia that wasn't causing an emergency.
What patients actually want, underneath all of it, is to understand their condition and to understand how their options will most expediently, efficiently, and effectively improve their current health — within the constraints of what their day-to-day life can tolerate, and with the least imposition over however many years they have left. That's the actual goal I'm working toward with almost every patient, whether or not we ever say so out loud.
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