Sunday, 4 March 2012

Goal-oriented patient care - an alternative health outcomes paradigm

Reuben & Tinetti. Goal-Oriented Patient Care - An Alternative Health Outcomes Paradigm. N Engl J Med 2012; 366:777-779. March 1, 2012.

"It is clear from reading some of your comments that a lot of MS'ers don't get out of their encounters with the healthcare system what they want. This perspective published in last week's New England Journal of Medicine addresses some of the aims of goal-orientated patient care. I suggest you read it in full and may be we could discuss some of the issues around this noble aim."


The following are two excerpts from the paper: 

... major efforts have been launched to make care more patient-centered, defined as “respectful of
and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”

... Ultimately, good medicine is about doing right for the patient. For patients with multiple chronic diseases, severe disability, or limited life expectancy, any accounting of how well we’re succeeding in providing care must above all consider patients’ preferred outcomes.

6 comments:

  1. If you have a. Kindle you can get two week free subscription to new England journal of medicine in magazine

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  2. Ultimately good medicine is about stopping young people from becoming disabled. Nice shiny outpatients areas, glossy brochures, patients involved in treatment decisions, blogs, etc etc are smoke and mirrors. Gladly swap all of this for a grumpy doctor in a grubby clinic, who could give me back my health. Everyone says that your health is your most precious possession, but when MS steals it the health profession are powerless.

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  3. I very much agree with the comment above.

    There is too much noise going on in the field of MS and not enough real results.

    Stop wasting money and resources creating outpatient paddocks with the correct feng shui where the design has been created to stop people in wheelchairs crossing paths with patients not yet in wheelchairs (because the latter will get scared by the former).

    I'm tired with all the superficial stuff. I have such a jaded opinion of MS health care in Britain and it seems many others are in agreement with me. Too much money and time is wasted in ego-driven projects and not enough is going to help in finding ways to cure MS.

    I get the idea, especially from reading the article in the New England Journal that the emphasis shouldn't be on fixing damage and should be focussed on keeping ill people content with their diseases.

    Shameful, really.

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  4. When doctors learn to make MSers healthy then they can sit in grubby clinics and be grumpy.
    In the meanwhile it's a good idea to improve patient experience to whatever extent possible.

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  5. The only patient experience I want is the one where the doctor says take two of these for the next three months and you should be running again? Neurology needs to learn some lessons from the cancer field - massive advances and improvements in survival rates. The only research which should be funded should be research which leads to treatments. No more wholly social science stuff and no more research which states the obvious e.g. MS affect the whole family. The funding should shift to projects such as the Charcot Project. The shake up I'd like to see:

    1. A shift from MS being an academic subject to a branch of medicine (for too long the former has been the priority).
    2. Time to ditch the mouse model (we got 25 years of experimenting on humans (drug trials, post mortem examinations).
    3. A global strategy to deliver treatments which firstly halt the disease and, secondly, reverse damage. Proper co-ordination across the globe will avoid duplication of effort and address the sillos which result from the academic approach to the disease (where peer reviewed papers are thew measure of success).

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  6. "The only patient experience I want is the one where the doctor says take two of these for the next three months and you should be running again?"

    Hey man what planet are you on? Or better still what stuff have you been smoking? I need some of it.

    ReplyDelete

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