The Misaligned Compass of Modern Healthcare: Rediscovering What Patients Truly Want
Joshua Tamayo-Sarver, MD, PhD, FACEP, FAMIA
I vividly remember the moment when my son, a college freshman and competitive soccer player, casually mentioned he was heading to the gym to “get healthy.” Now, this is a kid who had spent years training at an elite level: two-hour practices four days a week and full minutes in weekend games. He was leaner than a triathlete and fitter than a fiddle. So, naturally, I raised an eyebrow. “Get healthy?” I asked. “What does that even mean for someone like you?”
Of course, we both knew what he really meant. He wasn’t going to the gym for health reasons; he was going because he wanted to bulk up and, let’s face it, improve his chances of getting a girlfriend. But here’s the kicker: if I had taken his statement at face value, I might have started lecturing him about balanced diets or aerobic capacity. I might have handed him a pamphlet on VO2 max or plastered food pyramid posters on his dorm walls. None of that would have resonated with his actual goal.
This disconnect between what people say they want and what they’re truly seeking is not unique to college kids in gyms. It’s pervasive in healthcare, and it’s costing us, not just in dollars but also in trust, outcomes, and efficiency.
The Standard of Care Isn’t Enough
Healthcare prides itself on delivering the standard of care. And in many ways, we do this well. If you show up to the emergency department with chest pain, you’ll get a thorough workup tailored to rule out heart attacks, blood clots, or other life-threatening conditions. But what if your real concern isn’t whether you’re having a heart attack? What if your true fear is that you might have cancer because your coworker, who never smoked, was recently diagnosed with lung cancer?
Here’s what happens: you leave the ER reassured that your heart is fine but still plagued by the same chest pain and unanswered questions. So you go to urgent care, then your primary care doctor, then another specialist or even back to the ER, all in search of someone who will address the actual concern driving your behavior. The system pats itself on the back for delivering excellent care at every step while ignoring the fact that you’re still stuck in a cycle of fear and uncertainty.
This isn’t just inefficient; it’s profoundly wasteful. We’re not failing because we’re delivering bad care, we’re failing because we’re not addressing what patients are truly trying to accomplish.
The Healthcare System as a Public Utility
Reflecting on this misalignment reminds me of how phone service used to work when I was growing up. Back then, you didn’t have options like unlimited data or customizable plans; you just had a “phone plan.” It covered basic calls and maybe long-distance for an extra fee. It was functional but rigid, designed around what the provider could deliver rather than what the customer actually needed.
Healthcare today feels eerily similar. It operates like an outdated public utility: standardized offerings with little regard for personalization or individual goals. If you show up with “chest pain,” you get the “chest pain plan.” If you come in for “wellness,” you get generic advice about eating better and exercising more, whether or not that aligns with your personal motivations.
But here’s the thing: people don’t seek healthcare because they want to be healthy in some abstract sense. They seek it because they want to solve specific problems or achieve specific goals. And until we start aligning our care delivery with those goals, we’ll continue spinning our wheels.
Aligning Care With Patient Goals
So how do we fix this? How do we move from delivering standardized care to delivering goal-oriented care? The answer lies in understanding what patients are truly trying to accomplish — and designing our systems around those objectives.
1. Ask Better Questions
Stop assuming that patients’ stated symptoms are their ultimate concerns. Instead:
- Dig deeper into their motivations: “What are you most worried about?”
- Explore their goals: “What would make today’s visit feel successful for you?”
Acknowledge their fears: “Is there something specific you’re afraid this might be?”
2. Redefine Success Metrics
Shift from measuring success based solely on clinical outcomes (e.g., normal lab results) to incorporating patient-defined outcomes (e.g., peace of mind about cancer fears). This might mean:
- Following up after visits to ensure concerns were addressed.
- Tracking patient satisfaction with the basic, “did the encounter accomplish what they were wanting to accomplish?”
3. Tailor Interventions Around Motivations
Once you understand what patients are trying to achieve, align your recommendations accordingly:
- If a patient wants to feel “young and virile,” use that as an entry point to address broader health issues like cholesterol or blood pressure.
- If someone is worried about cancer despite low clinical suspicion, consider offering additional reassurance through imaging or follow-up rather than dismissing their concerns outright.
4. Leverage Behavioral Science
Borrow strategies from behavioral economics and psychology:
- Frame health interventions in ways that resonate with patients’ personal goals.
- Use motivational interviewing techniques to build alignment between clinical advice and patient priorities.
Lessons From Wellness Centers
I’ve seen these principles play out successfully in wellness centers that cater primarily to men seeking testosterone therapy. These patients often walk through the door because they want to feel youthful and energetic, not because they’re worried about cholesterol or diabetes. Yet by meeting them where they are (offering testosterone), these centers create opportunities to address broader health concerns like blood pressure, hemoglobin A1c levels, and mental health.
The result? Patients leave feeling better, not just physically but emotionally, because their core motivations were acknowledged and addressed. And along the way, they achieve better overall health outcomes as a natural byproduct.
A Call for Radical Empathy
At its core, this shift requires healthcare providers and systems to practice radical empathy. Delivering technically excellent care is not enough; we must also understand and respect what our patients are truly seeking when they walk through our doors.
This means letting go of our own assumptions about what patients should want and instead meeting them where they are, even if their goals seem trivial or misaligned with traditional healthcare priorities. Because here’s the truth: being healthy is rarely an end goal in itself. For most people, it’s simply a means to an end; a way to live longer, feel better, achieve dreams, or avoid fears.
So let’s stop treating health as if it’s some abstract ideal divorced from real life. Let’s start respecting what our patients actually want and designing systems that help them get there.
Dr. Joshua Tamayo-Sarver, MD, PhD, FACEP, FAMIA, develops and deploys technology solutions in the healthcare ecosystem as a clinician, business leader, software engineer, statistician, and social justice researcher. As the Vice President of Innovation at Inflect Health and Vituity, his unique formula of skills has helped develop over 35 solutions and scale multiple new healthcare products, including the first AI occult sepsis tool with FDA breakthrough designation. Dr. Tamayo-Sarver oversees corporate venture, internal incubation, and advisory services for AI-driven healthcare solutions, blending consumerism and clinical quality to fit the delicate balance of patient desire, user experience and quality medical care. A Harvard graduate, he holds degrees in biochemistry, epidemiology, and biostatistics, as well as a medical degree from Case Western Reserve University. He is a Mentor in the Emergence Program at Stanford University.
