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Align Medications With Goals of Care, Says Boyd

October 28, 2019
by Julie Parry

The Department of Internal Medicine’s Sixth Annual Robert S. Gordon Lecture, held on Thursday, October 24, was presented by Cynthia Boyd, MD, MPH, professor of Medicine, Division of Geriatric Medicine and Gerontology at Johns Hopkins University.

Boyd became interested in studying older adults with multiple chronic conditions after her residency experience. She was taking care of many patients with complex medical histories and ‘was struggling with what things to focus on first, how to interpret the evidence for these patients, and how to figure out which things people were likely to benefit from.’

In her 2005 JAMA publication, Boyd and her co-authors looked at clinical practice guidelines and how they would apply to older individuals with several diseases. They created a chart for “Recommendations Based on Clinical Practice Guidelines for a Hypothetical 79-Year-Old Woman With Hypertension, Diabetes Mellitus, Osteoarthritis, Osteoporosis, and COPD,” which Boyd called complex. She joked that she couldn’t fit the chart on a single piece of paper.

“We really want to think about which things are most important,” advised Boyd.

Boyd shared what it is like to live with multiple chronic conditions from both the patient and caregiver points-of-view, the burden of disease and the key elements of patient-centered care.

Additionally, Boyd highlighted the Patient Priorities Care work by Mary Tinetti, MD, Gladys Phillips Crofoot Professor of Medicine (Geriatrics) and section chief of Geriatrics; and the American Geriatrics Society Guiding Principles, in which Terri Fried, MD, professor of geriatrics contributed, and other work done within the section.

She acknowledged that progress has been made, but there ‘is a lot of work still to be done.’

“As we think about medicine, we need to recognize that benefits may change over time and what matters to people is important. Our patients are really willing to discuss deprescribing, but we need to do this in a way where we are aligning the treatment plan with patient goals.”

The Robert S. Gordon Lecture was established in memory of Gordon, an associate professor of clinical medicine at Yale School of Medicine, to support continued medical education. Gordon completed his postgraduate medical training in internal medicine at Yale, including a year as chief medical resident followed by a fellowship in cardiology. He worked as an internist in New Haven for nearly 50 years until he retired at 82.

To watch Medical Grand Rounds, review the Grand Rounds video.

Submitted by Julie Parry on October 28, 2019