Doctors treating seriously ill patients must shift from a problem-centered approach to a goal-centered approach to care, said Dr. Charles von Gunten, keynote speaker for the recent Hospice and Palliative Care Symposium at the Chicago Botanic Garden. “Some doctors look at the parts and some doctors look at the bigger picture,” said Von Gunten, an end of life care expert and editor-in chief of the Journal of Palliative Medicine.

“If the goal here is to win, and living is winning– and Americans hate losing, we use a fighting metaphor for health care– what really is winning?” Von Gunten asked. “As much as we would like to think that we are independent health care professionals, doing what is best for the patient in our judgement, we are influenced by the signals in our environment about what is winning.” The environment of health care actually favors short-term, problem-centered care, he added.

Von Gunten broke down the differences between problem-centered care and goal-centered care: