Intended for healthcare professionals

Rapid response to:

Views And Reviews Taking Stock

Rammya Mathew: Learning to manage multimorbidity

BMJ 2020; 368 doi: (Published 10 March 2020) Cite this as: BMJ 2020;368:m871

Rapid Response:

Multimorbidity: a new challenge in health care

Dear Editor
I work in A&E. I have full access to the GP notes. Contextualising the “acute” presentation in complex patients with multimorbidity can take me 30 mins. At 30 mins I am just about ready to properly assess the acute issue and make a decision. If I don’t contextualise I am aware that my decision may be 180 degrees different. Having good enough knowledge to assess many conditions is a real challenge. And knowledge is not enough: you need experience as well but there so many diagnoses around and new treatments that you will never be good enough. Adequacy is all you can hope for and sometimes you are bordering on the ignorant and having to make decisions all the same. However that is less dangerous than not contextualising.
Now this sort of consultation is becoming the norm and the easy contact with a single isolated issue is becoming a minority.
I suspect that one of the reasons GP is struggling is that the “easy” consultations are disappearing. You need much more time with this increasingly group of patients and the knowledge and experience you have to have just to make an “OK” decision is vast and almost unobtainable. So many variables means error is almost inevitable. With hindsight the error can look basic but of course the lawyers never “contextualise” the consultation.

Competing interests: No competing interests

15 March 2020
Graeme Mackenzie