I recently asked a women in my clinic about her medical history. She joked and said “Have you got all day?”
The conversation reminded me of the days when some patients would arrive at their appointment accompanied by a trolley full of notes. These people had multiple long-term conditions, referred to as ‘multimorbidity’.
About a quarter of the UK population, and more than half of people aged over 65 years have multimorbidity. Most of my patients visit me to discuss multiple conditions. Reading all of their notes before each consultation is impractical and current research focuses on managing a single condition, so how should I support my patients?
The recently published NICE guideline for managing multimorbidity has helped tremendously.
The guideline recommends healthcare professionals scan their patients’ records to identify and recognise multimorbidity as a potential issue.
It also says we should ask our patients what matters to them most and empower them to set the agenda. I consider this sound advice as most of my patients can summarise their conditions and symptoms far better than any trolley of notes. By talking to my patients and following their lead I can work with them to set clear goals and formulate a management plan they’ll follow.
NICE also says medication review is vital because someone with multiple conditions is likely to be on multiple medications, which increases the risk of drug interactions.
I am never happy on a ward round until I have made liberal use of my “geriatrician’s scalpel” (a nickname for my red pen) to stop unnecessary prescriptions.
Some groups have suggested we can replace GPs with mobile apps or move to a model of drop-in sessions where patients see a different doctor each time. However, continuity of care is very important and NICE recognises this by reflecting the aims of Slow Medicine, Realistic Medicine and Choosing Wisely campaigns.
Perhaps we are finally recognising that designing healthcare around patients with a single illness does not always work. Multimorbidity is the new normal and we must adopt a different approach.