Patients and physicians alike struggle to grasp how risk factors, treatments, and diseases interact within the same person. When seeing a frustrated 70-year-old man with hypertension, insomnia, and severe osteoarthritis in primary care, what strategy will help him most? The common definition for multimorbidity, using the number of diagnoses, is useful for epidemiologists but not clinicians in their management of individual patients. Maybe we can rethink our approach.
THE ORIGINS OF MULTIMORBIDITY
We try to help patients using common scripts for diagnosis and treatment. Prospective cohorts and experimental trials provide average prognoses and expected effects of interventions for those with clearly defined diseases who we think of as standard patients. Health systems rely on common definitions for everything from patient discussion forums to billing. However, with ageing patients and improved detection, we rarely see standard patients in primary care. A 1976 German publication coined ‘Multimorbidity’ to describe the co-occurrence of multiple diseases or medical problems.1 Other terms followed, such as comorbid and polypathy. Observational cohorts based on the number of physical or mental morbidities have shown that patients with multiple diagnoses, on average, experience more fragmented care, suffer from more treatment side effects, and have a lower quality of life than those with one or no diagnoses.2
CLINICAL MEANINGFULNESS (CAN WE DIAGNOSE AND TREAT MULTIMORBIDITY?)
An implicit question underlying this concept is whether there are latent, causal links and interactions between coexisting medical problems. One method is to identify clinically coherent patient groups with the same diseases and, theoretically, common goals for treatment. Initial epidemiological studies found certain …
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