Patients can be caught in a clash between goal-oriented and problem-oriented perspectives. De Maeseneer describes the case of an older patient with osteoarthritis, hypertension, type 2 diabetes and chronic airways disease who articulated what mattered most: "On Tuesdays and Thursdays I want to visit my friends… and play cards with them. On Saturday I want to go to the supermarket with my daughter. Foremost, I just want peace. I don’t want to continually change the therapy anymore, especially not having to do this and do that."
A doctor focusing on solving clinical problems by titrating multiple medications to make the patient normotensive, reduce HbA1C to levels defined by national guidelines, and achieve lung function tests that are normal for age and body habitus will miss the point. The patient's goals are primarily cognitive clarity and a certain amount of mobility.
Goal-oriented care is care that "encourages each individual to achieve the highest level of health as defined by that individual". The majority of the tools help patients achieve their goals rather than solve physiologic problems. Hence providers who choose to mobilize these tools in pursuit of a strategy of patient engagement and promotion of self-care will have to first clarify their purpose for doing so and recognize the implied change in their goals as providers.
Successful healthcare needs active patients. Active patients not only work with medical issues but also functional, social and psychological issues.