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Own The Goal

December 10, 2012

I recently read in a blog post (somewhere I can’t remember right now) about an health care system that had started instituting Patient Health Care Goals.  Like, YOUR goals, not your doctors goals.

This strikes me as an innovation that should be obvious and yet is not.  If you car to get fixed, you go to a mechanic, he tells you all the things that are wrong with the car, and you decide what to fix based on your goals for the car, it’s value, how much you’re willing to spend, etc.  If you go to your primary care doctor and tell him you want to get fixed, he/she will come back with a whole list of things that are wrong with you and then it’s HIS responsibility, legally and financially, to make sure you fix ALL of them, regardless of whether you want to, regardless of whether it fits with your lifestyle and values, how much you’re willing to invest, etc.  In fact, if your doctor finds something wrong and doesn’t attempt to fix it he gets dinged in the pocketbook and in “quality” care metrics.  If your mechanic says you need a new muffler but you don’t want one, nobody calls up the mechanic and tell him he’s not delivering quality care to your car.

In another example, over the weekend the New York Times had an article on a patient who had a terminal illness who’s goal was to make it to an landmark life event.  HIS goal.

The point is that doctors are trained to fix stuff, and they don’t feel like they’ve done a good job unless everything gets fixed.  But maybe you don’t want to be fixed or think nothings broken. Or you’d like to be fixed but the price is too high or the sacrifice too great. OK.  In our current system, however, you’re not wanting to get better reflects badly on the doctor unfortunately.  Set your own health goals.  Tell your doctor what they are, ask him to help you meet them.  Her goals are unlikely to be exactly the same as yours.  The doctor might want you to cut down on sugar so your blood sugar levels will be more normal.  Your goal might be to enjoy your daughter’s 40th birthday cake.  Fine.  Eat the cake and find a way to cut back in some other way.

Or eat the cake and say to hell with you, doctor.  You can do that too.  It’s not the doctors job to fix you. It’s yours.  Patients tend to secede responsibility for their health to the doctor.  “Doctor, you make me better.”   Well, yes, but you have to do your part too.  Set your own health goals.  You’re much more likely to reach them.

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