title: Goal-Directed Health Care and the chronic pain patient: a new vision of the healing encounter.
abstract: We introduce a new way to engage the patient with chronic pain, Goal-Directed Health Care (G-DHC). Identifying the patient's major life goals during the medical interview is the key element of this approach along with connecting these life goals to specific health-related goals. The implementation of G-DHC is a shift in process from the usual focus on disease-related goals such as relief of pain, titrating narcotic refills, and working on condition management to broader, long-term, personal goals. It emphasizes the importance of identifying the global life goals of patients and the reasons they wish to be well for and what they would do with improved health once they had it. Utilizing these life goals as a point of reference, discussion, and motivation makes clearer what specified health goals mean, whether or not the patient is ready to work on them, and most significantly, what the underlying motivation is to participate in their own care. We anticipate such a model of patient-centered care will shift the dynamic of the medical encounter with the patient with chronic pain to one that is ultimately more productive and satisfying for both patient and physician. Illustrations of cases, questions to ask patients, and a detail of the process may allow the reader to adopt this method into their practice.
authors.affiliation: Department of Family Medicine, University of Virginia, Charlottesville, VA 22903, USA. dbw@virginia.edu
authors.forename: David
authors.initials: D
authors.lastname: Waters
authors.forename: Victor S
authors.initials: VS
authors.lastname: Sierpina
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D005260:Female; D006040:Goals; D006694:Holistic Health; D006801:Humans; D008875:Middle Aged; D010148:Intractable Pain / Q000523:psychology* / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology; D010817:Physician-Patient Relations; D011787:Quality of Health Care / Q000592:standards / Q000639:trends
chemical_list: D000700:Analgesics