Existential Competence: Redefining Clinical Excellence Beyond Health Optimization

abstract: Clinicians often focus on measurable health improvements, while patients may prioritize other values, such as autonomy, comfort, and quality of life. This divergence can generate tension between technical excellence and meaningful care. This article introduces "existential competence" as a professional skill for navigating this tension. Existential competence helps patients align health-care decisions with what gives their lives purpose, recognizing health as only one source of human flourishing. Clinicians cultivate this skill by respecting patient choices—healthy or not—that reflect the patient's core values and remain within legal bounds, assuming stable preferences, decision-making capacity, and understanding of the risks. Implementation of existential competence requires expanding health care from risk management to co-stewardship of patients' life narratives, while maintaining clinical accountability. Two approaches are considered: repositioning health as one value among many, versus redefining health to encompass existential well-being. Ultimately, existential competence reorients health care toward helping patients thrive by integrating biomedical expertise with the pursuit of meaningful living.