Goal Oriented Medical Care

The premise of Goal-Oriented Medical Care is that, prior to consideration of strategies, the health care team must understand the patient's personal health goals and priorities. While intuitively obvious, addition of the goal-clarification step changes the focus from problem-solving to goal attainment, forcing a reconsideration of the meaning of health and the purpose of health care. It elevates the role of patients in decision-making, broadens the range of strategies, encourages individualization and prioritization, and creates a conceptual framework for true person-centered care. And while the idea is deceptively simple, it provides a blueprint for the transformation of health care systems trying to adapt to changing health concerns, scientific and technological advances, health and health care inequities, and rising costs. This book was written primarily to introduce goal-oriented medical care to physicians and other health care professionals, but it should be of interest to health care administrators and policy-makers as well.

Recent evidence has shown that the successful setting of goals brings about positive outcomes in psychological therapy. Goals help to focus and direct clients' and therapists' attention in therapeutic work. They also engender hope and help energise clients. No longer are clients victims of their circumstances, but through goal setting they become people who have the potential to act towards and achieve their desired futures. Through the discussing and setting of goals, clients develop a deeper insight into what it is that they really want in life: a crucial first step towards being able to get there. Recent policies in both child and adult mental health services have supported the use of goals in therapy. However, the differing cultures, histories, psychologies, and philosophical assumptions of each form of therapy has brought about varying attitudes and approaches to goal setting. Working with Goals in Counselling and Psychotherapy brings the attitudes of all the major therapeutic orientations together in one volume. With examples from cognitive behaviour therapy, psychodynamic therapy, humanistic therapy, interpersonal therapy, and systemic therapy Working with Goals in Counselling and Psychotherapy truly is the definitive guide for therapists seeking to work with goals in any of the psychological therapies.

It is important that each of us understand and communicate our personal health goals in order to maintain good health and receive good health care. We all hope to avoid premature death and disability, participate in meaningful life activities, become more capable and adaptable, and experience a comfortable death. However, each of us defines these goals differently, and we differ in the strategies we choose to achieve them. In this book, the author, a primary care physician and teacher, uses case examples and practical advice to help readers clarify their health goals, understand the kinds of strategies likely to be effective, and understand the health care system in order to get the help they need and avoid unnecessary tests and treatments. The book includes 16 chapters divided into 3 sections, The Goals of Health and Health Care, Obstacles and Challenges, and Achieving Your Health Goals. The first 14 chapters are followed by questions for contemplation or discussion. The book has 256 pages.

Containing papers carefully compiled for both their historical importance and contemporary relevance, Family Medicine: The Classic Papers brings together a team of experts, led by global family medicine leaders Michael Kidd, Iona Heath and Amanda Howe, who explain the importance of each selected paper and how it contributes to international health care, current practice and research. The papers demonstrate the broad scope of primary health care delivered by family doctors around the world, showcasing some of the most important research ever carried out in family medicine and primary care. This unique volume will serve as an inspiration to current family doctors and family medicine researchers and educators, as well as to doctors in training, medical students and emerging researchers in family medicine.

The Patient-Centered Clinical Method (PCCM) has been a core tenet of the practice and teaching of medicine since the first edition of Patient-Centered Medicine - Transforming the Clinical Method was published in 1995. This timely fourth edition continues to define the principles underpinning the patient-centered clinical method using four major components, clarifying its evolution and consequent development, and it brings the reader fully up to date. It reinforces the relevance of the method in the current much-changed realities of health care in a world where virtual care will remain common, dependence on technology is rising, and societal changes away from compassion, equity, and relationships toward confrontation, inequity, and self-absorption. Fully revised by its highly experienced author team ensuring wide interest and written for those practising now and for the practitioners of the future, this new edition will be welcomed by a wide international audience comprising all health professionals from medicine, nursing, social work, occupational therapy, physical therapy, pharmacy, veterinary medicine, and other fields.

A family orientation in health care can provide a wider understanding of illness and a broader range of solutions than the classic biomedical model. This volume thus offers practical guidance for the physician who would like to take greater advantage of this resource. The result is a readable guide, structured around step-by-step protocols that are vividly illustrated with case studies drawn from the authors extensive experience at the University of Rochester School of Medicine.

This book provides family doctors with a wealth of evidence-based indications and tips regarding geriatric medicine and approaches for the management of older patients, to be applied in daily practice. After discussing old and new features of healthy ageing and the approaches required in Family Medicine Consultation, the text introduces key elements of geriatric medicine such as frailty, sarcopenia, and the comprehensive geriatric assessment (CGA), before describing a range of characteristics unique to older patients in different contexts, with a dedicated section on Palliative Care. The role of polypharmacy and the importance of quaternary prevention and deprescribing are also addressed. Finally, the book emphasizes both the importance of a humanistic approach in caring and the approach of research and meta-research in geriatrics. Though many texts explore the role of primary care professionals in geriatric medicine, the role of family doctors in older people care has not yet been clearly addressed, despite the growing burden of ageing, which has been dubbed the “silver tsunami.” Family physicians care for individuals in the context of their family, community, and culture, respecting the autonomy of their patients. In negotiating management plans with their patients, family doctors integrate physical, psychological, social, cultural and existential factors, utilizing the knowledge and trust engendered by repeated visits. They do so by promoting health, preventing disease, providing cures, care, or palliation and promoting patient empowerment and self-management. This will likely become all the more important, since we are witnessing a global demographic shift and family doctors will be responsible for and involved in caring for a growing population of older patients. This book is intended for family medicine trainees and professionals, but can also be a useful tool for geriatricians, helping them to better understand some features of primary care and to more fruitfully interact with family doctors.

Patient-centered care for chronic illness is founded upon the informed and activated patient, but we are not clear what this means. We must understand patients as subjects who know things and as agents who do things. Bioethics has urged us to respect patient autonomy, but it has understood this autonomy narrowly in terms of informed consent for treatment choice. In chronic illness care, the ethical and clinical challenge is to not just respect, but to promote patient autonomy, understood broadly as the patients' overall agency or capacity for action. The primary barrier to patient action in chronic illness is not clinicians dictating treatment choice, but clinicians dictating the nature of the clinical problem. The patient's perspective on clinical problems is now often added to the objective-disease perspective of clinicians as health-related quality of life (HRQL). But HRQL is merely a hybrid transitional concept between disease-focused and health-focused goals for clinical care. Truly patient-centered care requires a sense of patient-centered health that is perceived by the patient and defined in terms of the patient's vital goals. Patient action is an essential means to this patient-centered health, as well as an essential component of this health. This action is not extrinsically motivated adherence, but intrinsically motivated striving for vital goals. Modern pathophysiological medicine has trouble understanding both patient action and health. The self-moving and self-healing capacities of patients can be understood only if we understand their roots in the biological autonomy of organisms. Taking the patient as the primary perceiver and producer of health has the following policy implications: 1] Care will become patient-centered only when the patient is the primary customer of care. 2] Professional health services are not the principal source of population health, and may lead to clinical, social and cultural iatrogenic injury. 3] Social justice demands equity in health capability more than equal access to health services.