Letters Guidelines and multimorbidity

Forcing reality into inappropriate disciplinary frameworks

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7385 (Published 06 November 2012) Cite this as: BMJ 2012;345:e7385
  1. David P Kernick, general practitioner1
  1. 1Devon Primary Care Trust, St Thomas Medical Group, Exeter EX4 1HJ, UK
  1. david.kernick{at}nhs.net

The article on adapting clinical guidelines to take account of multimorbidity builds on the reductionist misconception that each disease can be identified and managed individually.1 Rather than forcing reality into the prevailing disciplinary matrix it is more appropriate to match the analytical approach to the complexity of the task within a broader theoretical framework. For example, ordered domains (simple, complicated), transitional domains, and unordered domains (complex and chaotic).2

There is also a danger of creating organisational arrangements and incentive structures that lead to conditions that favour the predictions made in theory, thus reinforcing inappropriate models of care, service delivery, and clinical governance.

Confronting the challenges of multimorbidity will need an understanding of the sensitivity of different analytical perspectives. It will also need a diversity of healthcare delivery frameworks that are appropriate for the particular system under consideration.


Cite this as: BMJ 2012;345:e7385


  • Competing interests: None declared.