What Matters
The Institute for Healthcare Improvement along with the John A Hartford Foundation, American Hospital Association, and the Catholic Health Association of the United States developed a framework for Age Friendly Health Systems. You can see a brief overview of this under the “4Ms” on the Basics page.
Today, let’s dive deep into the first of the four. “What Matters.” This is the jumping off point for the other three, because it helps healthcare workers, caregivers, and patients all become like-minded in the patient’s health goals. As we age, some people are willing to trade time for quality and some are not. Both of those are valid, and as healthcare workers we want to be on the same page as our patients and caregivers. There may be times when your physician will recommend testing or treating certain conditions or recommend holding on testing or treating depending on a your health goals or status. A common example is cancer screening; around age 75 for most cancer screenings there is a switch from obtaining measurable benefit from screening to an increased risk of harms. More of what are called “incidentalomas” are found, which can cause significant psychological and physical distress. These are small spots or lumps, depending on the type of screening, that require further workup but turn out to be benign findings. Patients and caregivers can experience significant psychological distress of a possible cancer diagnosis let alone the physical demands of invasive testing.
This is why it is important to have honest and open discussions with the people in our lives about “What Matters” in their lives. Some helpful questions to ask are:
“What do you want to be able to do as you age?”
“What is one thing you want to focus on in your health?”
“What are you willing to do for your aging health?”
“What are you not willing to do for your health? What are you unable to do?”
As a geriatrician, if a patient and/or caregiver has answered these questions it establishes a foundation for care. It also helps guide even harder conversations, such as “How do you see your life ending?” (Spoiler alert, no one gets out alive). To have that foundation is essential in ensuring person centered care and giving everyone the quality of life they seek.
Key Points:
Appoint a medical decision maker in the event you are incapacitated
Communicate with that decision maker and your physician your health goals
DO WHAT MATTERS IN YOUR LIFE!
