Here’s how to stay on top of your health—and focus on the things you enjoy most…
A trip to the doctor or lab can take up to half a day when you include transportation and waiting time. Medications can sap your energy and cloud your thinking, while special diets and exercises can put a crimp in your lifestyle.
If you have more than one chronic condition—as do 67% of adults age 65 and older—you can double, triple or quadruple your doctor visits, tests and medications. It’s no small wonder that many patients feel overburdened by their medical care.
Your health is precious to you, because it allows you to live your life the way you want—to do activities that bring you pleasure and to connect with people you love and give meaning to your life. If you must sacrifice whatever makes life worth living, you may wonder what’s the point of that health care?
In an ideal world, medical care would fix our health problems and allow us to have full, rewarding lives without any hassle or discomfort. But in reality, trade-offs are almost always necessary. We must decide what’s truly important to us and what we’re willing to give up for the sake of our health.
Better way: A new approach looks at the way a person’s medical care fits with his/her life priorities so that smart choices can be made by patients and their doctors. Here’s how…
What are your priorities?
Everyone’s priorities are different. For one person, it means being free enough from pain to be able to walk more. Another wants to keep a clear head and remain alert enough to drive—even at the price of some discomfort.
While you are the expert in what matters most and what you’re willing to do or give up in a trade-off, your doctors are experts in how to achieve your goals. That’s why you need to work together. Helping people do that is the idea behind “Patient Priorities Care,” a program designed and developed by a research team that includes patients, doctors and scientists at Yale University, New York University and Baylor College of Medicine.
In a pilot study, the research team showed that this approach, which incorporates the patient’s assessment of how his/her life priorities fit into treatment decisions, can work in a busy medical practice. A member of the health-care team can help patients identify their health priorities—what they want to focus on in their health care while clinicians can learn how to align their care with these priorities—all without much extra time. Patients and clinicians report liking this approach.
Based on the program’s principles, The American Geriatrics Society has recommended that doctors put these ideas into action when working with older adults who have multiple medical conditions. And the research group is working to expand the program into the health-care community at large.
Putting patients first
When using this program, patients are guided by a nurse or other health-care professional through a systematic process to specify their personal health outcome goals and identify the aspects of their medical care that they feel either advance these goals or are too difficult, burdensome or unhelpful.
Participants begin by identifying their “core values” that don’t change as life circumstances and health change—things that mean the most to them, such as relationships, independence, longevity and physical and mental capacity. They then pinpoint specific, achievable activities linked to their core values. For one person, it may be seeing her grandchildren every week…for another, it may be a desire to be strong and clear-headed enough to travel.
Doctors and other health-care professionals are trained to elicit and respond to patients’ concerns…and to tailor treatment to what they value. Communication in both directions—patients getting their needs and values across, and doctors making it clear what goals are realistic and what trade-offs will be involved—is essential.
Try this at home
Even though Patient Priorities Care was designed for use with professional guidance, you can gain many of the same benefits on your own.
Step 1: Start by creating a road map of your own priorities by considering what aspects of life you value most.
For example, ask yourself…
- What relationships mean the most to you?
- What gives you particular pleasure?
- What aspects of function do you value most highly—for example, independence…keeping your mind sharp…maintaining physical abilities…and/or learning new things?
- What do you most want from medical care? For example, is a long life or highest quality of life more important? What about freedom from pain?
Step 2: Consider three specific, realistic activities that allow you to realize these core values—ones that you’d hate to give up. Examples: Walking to the park daily to see friends…driving yourself to your weekly poker or bridge game…traveling abroad with a loved one.
Step 3: Consider what aspects of your health care help you achieve these goals—for example, medication that relieves pain so you can walk or regular exercise that boosts your mood.
Step 4: Consider three aspects of your health care (for example, medications, health-care visits, tests or procedures or self-management tasks) that get in the way of achieving your goals or that you find too difficult or burdensome. Examples might include drugs that make you too tired to socialize…or a prescribed diet that forbids your favorite foods.
Step 5: Once you have identified your personal priorities, work with your doctor—or doctors—to align your health-care goals with them. Your task is to make your doctor understand that even though optimal results for each of your diseases are desired, other things also matter—maybe even more—to you.
These conversations may be challenging. Doctors are trained to focus on diagnosing diseases and then choosing effective treatments for them. But if you say very explicitly what you care about, they will find it hard to ignore. Be simple and direct: “I really want to focus on being able to visit my family regularly, so what should we work on to enable me to do this?”
Also, share what aspects of your health care you think make it hard to achieve your goals. The more information the doctor has, the better you can work out trade-offs with acceptable risks and optimal benefits. For example, if you have diabetes, you may be willing to stick to a diet that helps stabilize your blood sugar but want to forgo taking insulin shots because of the inconvenience of the shots and difficulty that you have self-administering them. You are willing to consider oral medications that help control your blood sugar.
Another trade-off might be to reduce blood pressure medications that make you too tired or dizzy to complete your desired exercise routine even if it means a small increase in your risk of having a stroke down the road.
It’s an ongoing process. Whenever the doctor prescribes new medication or orders tests, ask, for example, “Staying physically active is what really matters to me. Is this treatment/test likely to help me do it better?” Keep your goals flexible, too. A change in your condition, such as a stroke or worsening of arthritis, may alter what you can realistically expect to achieve.
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