The Whole Patient — Toward Holistic, High-Value Care | NEJM

Why It Matters

Holistic, home‑based primary care reduces low‑value services and aligns treatment with patient goals, offering payers and providers a pathway to lower costs and higher satisfaction.

Key Takeaways

• Home visits reveal patients' functional status beyond clinic data
• Holistic assessments reduce low‑value tests and unnecessary interventions
• Longer, relationship‑focused encounters improve prescribing quality for older adults
• Patient preferences guide treatment choices, emphasizing quality of life
• Payment models must support time‑intensive, value‑based primary care

Summary

The NEJM video “The Whole Patient — Toward Holistic, High‑Value Care” showcases a primary‑care model that brings physicians into patients’ homes to capture a complete picture of health, including mobility, cognition, daily activities, and social support. By stepping outside the traditional clinic, doctors can tailor interventions to the lived reality of older adults and avoid the blind spots that often lead to over‑testing.

Key insights include the link between longer, relationship‑focused visits and reduced low‑value care, such as fewer inappropriate antibiotics for viral colds. The presenters cite a study showing that extended encounters lower the likelihood of unnecessary prescriptions, and they illustrate cascading harms with a personal story of a prostate‑cancer screening that triggered a chain of costly, risky procedures.

Notable moments feature Dr. Pound’s 29‑year relationship with Mr. Chang, the 92‑year‑old June Adams who fears falls, and Dr. Ganguli’s anecdote about his father’s unnecessary prostate screening. Students observing the home visits remark on how patients’ functional independence is often underestimated when assessed only in an office setting.

The implications are clear: health systems must redesign payment structures to reward time‑intensive, value‑based care and integrate home‑based primary care into routine practice. Aligning treatment decisions with patient‑centered goals—especially quality‑of‑life preferences—can curb wasteful spending while improving outcomes.

Original Description

In this Double Take video from the New England Journal of Medicine, Drs. Pound and Ganguli discuss the importance and benefits of a comprehensive patient centered approach to treating older patients. They show how such efforts can provide high-value care and improve the quality of life for this patient population.

For further reading, the following articles, referenced in the video, are available at NEJM.org:

How Does Health Care Burden Patients? Let Me Count the Days (https://www.nejm.org/doi/full/10.1056/NEJMp2402138 Ganguli, in the September 12, 2024, issue of the Journal).

Age, Complexity, and Crisis — A Prescription for Progress in Pandemic (https://www.nejm.org/doi/full/10.1056/NEJMp2006115 Aronson, in the July 2, 2020, issue of the Journal).

The New England Journal of Medicine is the world’s leading general medical journal. Continuously published for over 200 years, the Journal publishes peer-reviewed research along with interactive clinical content for physicians, educators, and the global medical community at NEJM.org.