Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Lightening the load 


Clinicians can prioritize patient well-being by discussing the burden of engaging in care. Collaborate with patients to ensure recommendations are feasible and consider alternative approaches if necessary. 

I recently spoke to a patient of mine who said she stopped going to her recommended outpatient physical therapy sessions for hip pain. She told me she didn’t want to come back to see me again because “I was always making appointments.” Over the past year she’s had many medical appointments related to her cancer, reconstructive surgery, arthritis, and extensive dental work. She had come to feel that her life revolved around so many appointments, which felt overwhelming and time-consuming. 


An article I read recently in USA Today (April 7, 2024, “Getting medical care can exhaust older patients”) suggests she’s not alone in these feelings. The article cites a new study that indicates that Medicare patients spend up to three weeks annually going to doctors in various clinics and facilities. The author observes, quite insightfully, that our healthcare system too often lacks coordination. Furthermore, we tend to expect our patients to manage complicated medical referrals and schedules, including making and attending appointments for outpatient tests and procedures from multiple clinicians. The workload can be compounded when both partners in a household have complex medical needs. Added to this is the challenge that many patients, particularly seniors, face in using electronic health records and electronic patient portals. The result can be treatment burden overload. 


While medical recommendations have good intentions and are appropriately focused on the patient’s healthcare needs, there can be negative consequences. For instance, patients may discontinue rehabilitation therapies before achieving full benefits. Or they may fail to follow through on making recommended appointments or making lifestyle changes that seem too burdensome to carry out. 


What can be done to ease treatment burden overload for patients? There are no simple answers but perhaps we, as clinicians, can start by having candid discussions with our patients. In reviewing new medical recommendations with our patients, we should ask quite simply if they are doable. We should also ask if they have other medical appointments already scheduled or recommended, have any anticipated challenges in terms of making the appointment, and if there are challenges in terms of getting to the appointment. Sometimes the response might be for the clinician to reconsider whether a particular recommendation is necessary, or whether modifications could be made, or assistance provided in another way. When we have a better understanding of the potential treatment burden for patients, we can be more helpful in problem-solving and supporting our patients to achieve their healthcare goals.  










This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.