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Do we neglect patients with multiple health problems?

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39524.519178.94 (Published 20 March 2008) Cite this as: BMJ 2008;336:670
  1. Rahij Anwar, specialist registrar, London, rahijanwar@hotmail.com,
  2. Nitish Gogi, registrar, West Midlands,
  3. Syed Neshat Anjum, registrar, London

    “Treat the whole patient, not just a particular disease” used to be the guiding principle for most clinicians until the government decided to reconfigure the way in which healthcare services in England would be offered. Under its new plans, primary care trusts or general practitioners would directly commission specialised services. The trusts would pay for the treatment of their patients in hospitals—and this, in due course, would become the hospitals’ main source of income. The aim of such commissioning was to save huge sums of money by using hospital services as sparingly as possible.

    Since its implementation this policy has not only jeopardised the future of many hospitals but has also led to considerable frustration and disappointment among patients. Perhaps the worst affected patients are those who have more than one condition at the same time. To primary care trusts these are very “expensive” patients, and therefore some of their problems might be “downplayed” to be managed in the community, and referrals to specialists are filtered.

    Constant …

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