Health and Medical News and Resources

General interest items edited by Janice Flahiff

Goal Oriented Patient Care

Photograph of a male doctor talking to a female patient


From the National Library of Medicine (NLM) Director’s Comments (5/14/2012)

The success of medical treatment might improve if the outcomes for persons with multiple conditions, severe disability, and short life expectancy were more based on a patient’s (rather than a health care provider’s) goals, suggests a stimulating commentary recently published in the New England Journal of Medicine.

The commentary’s two authors note the primary outcomes for patients with multiple conditions, severe disability, and short life expectancy often are based on medically-posited, condition-specific protocols. The authors add treatment success often is envisioned as meeting short and longer-term clinical indicators.

David Reuben M.D. and Mary Tinetti M.D. write (and we quote): ‘rather than asking what patients want, the culture has valued managing each disease as well as possible according to guidelines and population goals’ (end of quote).

However, the authors explain for patients with multiple conditions, severe disability, and short life expectancy (and we quote): ‘the overall quality of care depends on more than just disease-specific care processes’ (end of quote). As an alternative, the authors suggest a more patient-centered option should focus treatment on individual tailored goals, which might be quite different than what health care providers admirably hope to achieve.

The authors (who are from the University of California-Los Angeles and Yale University respectively) provide several hypothetical examples where a patient’s goals do not match the clinical indicators physicians seek and there may be differences in how physicians versus patients perceive the ultimate success of medical treatment….

Overall, underlying the commentary’s thought-provoking ideas is the foundational importance of good communication between doctors and patients, which is the focus of’s talking with your doctor health topic page.’s talking with your doctor health topic page provides an array of links to help you improve interpersonal communication with a health care provider. One highly useful site (from the Agency on Healthcare Research and Quality) provides 10 basic questions to ask a clinician that cover a wide range of medical situations. This website is available within the ‘overviews’ section of’s talking with your doctor health topic page.

A website from Harvard Medical School (available in the ‘related issues’ section) supplements the former site with specific questions about 40+ diseases and conditions that you can take with you to a doctor. Let’s Talk … and Listen also in the ‘related issues’ section helps you establish more rapport and shared decision making with a physician.’s talking with your doctor health topic page additionally contains updated research summaries, which are available within the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the talking with your doctor health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus….

May 21, 2012 - Posted by | health care | , ,

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