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Goal-Oriented Care: When Patients Decide What ‘Better’ Feels Like

Getting to the heart of "patient-centered" care. (University of Michigan MSIS/flickr)

There’s an important commentary in today’s New England Journal Of Medicine that gets to the heart of the sometimes murky notion of “patient-centered care” a buzzword of medicine these days.

The piece touts the virtues of goal-oriented care, that is, when patients, rather than doctors or researchers, express their own ideas about what ‘better’ health outcomes might be given their medical condition and life priorities. One example: A patient with Parkinson’s might feel that it’s more important to attend a grandchild’s graduation than to reduce his tremors, and so focus on that goal as a priority.

The authors, David B. Reuben, M.D., Division of Geriatrics, David Geffen School of Medicine at UCLA and Mary E. Tinetti, M.D, Department of Medicine, Yale School of Medicine, elaborate:

…a person with Parkinson’s disease may establish goals for symptoms, such as decreased rigidity and no falls; goals for functional status, such as the ability to get to the bathroom without assistance although requiring a walker; and goals for social function, such as the ability to use the Internet to communicate with a grandson at college and the ability to go to church. However, the patient may not be aiming to reduce tremor, walk without a walker, or continue to work for pay. Continue reading