Are we failing people with multiple health conditions? An expert discussionBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m921 (Published 09 March 2020) Cite this as: BMJ 2020;368:m921
- Gareth Iacobucci
- The BMJ
Jihad Malasi (JM), GP, clinical chair at Thanet Clinical Commissioning Group, clinical director for East Kent Hospital Transformation Services
Rammya Mathew (RM), GP, co-lead for quality improvement at Islington GP Federation, columnist for The BMJ
David Oliver (DO), consultant in geriatrics and acute internal medicine at Royal Berkshire Hospital, former vice president of the Royal College of Physicians, former president of the British Geriatrics Society, columnist for The BMJ
Louella Vaughan (LV), senior clinical research fellow at the Nuffield Trust, consultant acute physician at the Royal London Hospital
How do we define who we are treating and take a proactive approach?
RM: The definition of multimorbidity is two or more long term conditions. We probably do quite a good job for the people with two, but it’s the other end of the spectrum where we don’t. It’s not just people with five or six conditions, it’s also those with learning disabilities and with severe mental illness. The system just isn’t designed to meet their needs.
JM: Whether the person has two or four diseases is past the point for some of us, some of them have two complex diseases. And the medication is exponential; they have to have drugs to treat not only their primary disease but their secondary symptoms, the sequelae, and the rest.
DO: The shift we must make is towards proactive care planning, care coordination, shared care, and patient goals instead of constantly being in reactive mode. Our focus should be on people with multiple, life limiting, long term conditions. There’s an overlap between those people, people who …