Natalia Roldan, MD: Making patient preferences primary

November 5, 2015

By: Kim DiGioia, MSPH

“We don’t get to focus on things that mean the most to the patient or help us get to know them better,” laments Natalia Roldan, MD, chief medical resident in the Department of Internal Medicine at the University of Colorado Hospital. So she decided to do something to about it.

Roldan has learned from experience that the more a clinician knows about a patient, the better she is able to direct care in a way that is in line with the patient’s goals and treatment preferences.  She related a story about getting to know a patient who flew a bomber during the Vietnam War and was a prisoner of war for several months. This experience, she says, dramatically shaped him as a person, and informed his preferences for care. Being at home was his number one priority. Knowing this, his care team was able to help him spend as little time as possible in the hospital, and be as comfortable he could at home.

During RightCare Action Week, Roldan and other chief residents helped design a program that would educate residents about the problem of medical overuse, and would give them the opportunity to spend time really getting to know their patients. Monday through Thursday they held didactic sessions during their regular noon conference, asking residents questions like “Have you ever done or given anything to a patient that wasn’t going to change management?” “How did this unnecessary test or treatment affect the patient?” And then on Friday, the residents were given a free hour to have lunch with a patient. Over 50 residents participated, plus many advance practice providers with whom they work.

Roldan hopes that these small actions will result in better care, and that after hearing “the amazing stories about people’s lives” clinicians will be motivated to consistently have these conversations with their patients, despite time constraints.