Re: Beyond diagnosis: rising to the multimorbidity challenge
One wished that articles like this received much more attention and publicity than the likes of "Blood test that can predict Alzheimer's" which appeared in major newspaper headlines recently.
The former, timely and clearly defining the challenges of managing the "tsunami" of patients with multi-morbidity that are headed our way, and is relevant not only for Geriatricians and other physicians alike.
The later, sensationalist, and serving to divert precious attention, resources and manpower to ethereal ends and means.
It is striking that the majority, if not all, of the rapid responses to this article are from Geriatricians. Then again, it should not be surprising as by virtue of the special patient population of whom we serve, we have been dealing with multi-morbidity much longer than any other specialties, and have seen the full spectrum of chaos and iatrogenicity arising, when such patients are subjected to multiple single disease guidelines without consideration of the impact on their daily function or resulting lack of quality of life.
National initiatives in the form of "Payment by results" worldwide have ensured that "treatment by numbers" and "adherence to protocols and guidelines" takes precedence above everything else, including good clinical judgement on what is the best way forward for each individual patient.
One is no longer explicitly required to individually weigh the costs and benefits of treatments nor converse nor examine patients.
The fourth step in the practise of Evidence Based Medicine:
"Tailor the evidence to the needs and preference of the individual patient"
is side-lined or forgotten.
Such is the state and trend of Medicine and the brave new world that lies ahead of us, not just in UK but all over the world.
It brings to mind vividly the saying "The road to hell is paved with good intentions", and unless there is a paradigm shift in the politics of national healthcare across the globe, many of us will continue to be encouraged and incentivised to send our patients down this road.
To do different is to invite censure from management and colleagues, and sometimes, even from relatives and patients alike.
But to do different we must, if we are to uphold the single most important tenet of the National Health Service:
"In the patients best interest"
I agree wholeheartedly with Drs Byatt and Hyatt, that Geriatricians are best placed to rise to the challenge of multi-morbidity.
However, my personal non-evidenced observations would suggest that we can make the most impact by being in the frontline of care for patients with multi-morbidity, particularly in the elderly, rather than further down-stream where iatrogenicity have established itself and we are literally left to pick up the pieces.
The onus appears to be on us to demonstrate objectively that we can and do make a difference.
I hope that Dr Byatt and all other Geriatricians committed to delivering acute care not lose heart, despite the heavy burden that we bear and the many hats that we wear, as we continue to seek the best for our patients, elderly or otherwise.
Rapid Response:
Re: Beyond diagnosis: rising to the multimorbidity challenge
One wished that articles like this received much more attention and publicity than the likes of "Blood test that can predict Alzheimer's" which appeared in major newspaper headlines recently.
The former, timely and clearly defining the challenges of managing the "tsunami" of patients with multi-morbidity that are headed our way, and is relevant not only for Geriatricians and other physicians alike.
The later, sensationalist, and serving to divert precious attention, resources and manpower to ethereal ends and means.
See "On the hazards of significance testing."
(http://www.dcscience.net/?p=6473)
It is striking that the majority, if not all, of the rapid responses to this article are from Geriatricians. Then again, it should not be surprising as by virtue of the special patient population of whom we serve, we have been dealing with multi-morbidity much longer than any other specialties, and have seen the full spectrum of chaos and iatrogenicity arising, when such patients are subjected to multiple single disease guidelines without consideration of the impact on their daily function or resulting lack of quality of life.
National initiatives in the form of "Payment by results" worldwide have ensured that "treatment by numbers" and "adherence to protocols and guidelines" takes precedence above everything else, including good clinical judgement on what is the best way forward for each individual patient.
One is no longer explicitly required to individually weigh the costs and benefits of treatments nor converse nor examine patients.
The fourth step in the practise of Evidence Based Medicine:
"Tailor the evidence to the needs and preference of the individual patient"
is side-lined or forgotten.
Such is the state and trend of Medicine and the brave new world that lies ahead of us, not just in UK but all over the world.
It brings to mind vividly the saying "The road to hell is paved with good intentions", and unless there is a paradigm shift in the politics of national healthcare across the globe, many of us will continue to be encouraged and incentivised to send our patients down this road.
To do different is to invite censure from management and colleagues, and sometimes, even from relatives and patients alike.
But to do different we must, if we are to uphold the single most important tenet of the National Health Service:
"In the patients best interest"
I agree wholeheartedly with Drs Byatt and Hyatt, that Geriatricians are best placed to rise to the challenge of multi-morbidity.
However, my personal non-evidenced observations would suggest that we can make the most impact by being in the frontline of care for patients with multi-morbidity, particularly in the elderly, rather than further down-stream where iatrogenicity have established itself and we are literally left to pick up the pieces.
The onus appears to be on us to demonstrate objectively that we can and do make a difference.
I hope that Dr Byatt and all other Geriatricians committed to delivering acute care not lose heart, despite the heavy burden that we bear and the many hats that we wear, as we continue to seek the best for our patients, elderly or otherwise.
Thank you.
Competing interests: No competing interests