martes, 15 de mayo de 2012

NLM Director's Comments Transcript - Goal Oriented Patient Care

NLM Director's Comments Transcript - Goal Oriented Patient Care

A service of the U.S. National Library of Medicine
From the National Institutes of HealthNational Institutes of Health

NLM Director’s Comments Transcript
Goal Oriented Patient Care: 05/14/2012

Picture of Dr. LindbergGreetings from the National Library of Medicine and
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.listen

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.
For example, while a long–term indicator of a successful clinical intervention for persons with Parkinson’s Disease is to reduce tremors, the authors note if a Parkinson’s patient hopes to reduce falls and regularly attend church, the course of treatment (and adherence to physician instructions) might be quite different.
The authors explain a patient goal–oriented approach to making health care decisions, assessing outcomes, and measuring success has multiple advantages. Among them, the authors note a patient goal–attainment framework reframes the discussion about clinical care (and we quote): ‘in terms of individually desired rather than universally applied health states’ (end of quote).
If patient goals become the focus of care, then, the authors add (and we quote): ‘this approach allows for effective shared decision making, with the patient selecting the health outcome of highest priority and the clinician determining what treatment strategies are most likely to achieve that outcome. In effect, this is the patient-centered care equivalent of strategic planning’ (end of quote).
Although the authors acknowledge some patient goals may be unrealistic or attainable, they argue (and we quote): ‘ultimately good medicine is about doing right for the patient… any accounting of how well we’re succeeding in providing care must above all consider patients’ preferred outcomes’ (end of quote).
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.
To find’s talking with your doctor health topic page, type ‘talking with your doctor’ in the search box on’s home page, then, click on ‘talking with your doctor (National Library of Medicine).’
Other related health topic pages within include: personal health issues, and social/family issues.
Meanwhile, let’s hope the issues outlined in the commentary are widely discussed and its paradigm shift becomes increasingly common in medical practices throughout the U.S.
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A disclaimer – the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider. I want to take the opportunity to wish you a very happy holiday season and a healthy New Year. The National Library of Medicine and the 'Director's Comments' podcast staff, including Dr. Lindberg, appreciate your interest and company – and we hope to find new ways to serve you in 2012.
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