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In their timely critical analysis of “complex multimorbidity” Pati et al.1 highlight that multimorbidity is the norm rather than the exception in care. Moving beyond single-disease-based treatments is therefore vital. However, they question the value of measuring "complex multimorbidity" for clinical practice as definitions encompass varied phenomena and patient experiences.
We concur with the concerns expressed by Pati et al. and would go even further in questioning the value of current efforts in quantifying multimorbidity. Insights into the needs of patients are hard to quantify, and often ultimately a matter best judged in the specifics of each clinical encounter. Targeting efforts and resources towards managing multimorbidity through seeking more precise definitions and metrics may miss the mark.
The conceptual value of multimorbidity resides precisely in its capacity to prompt a shift beyond single-disease based understandings of illness. The ‘problem’ of multimorbidity emerges specifically in a context of care systems which have, over the past century, become increasingly specialized, standardised, and incentivised around single-disease-based approaches. This leads to high treatment burdens and polypharmacy for patients with multimorbidity. Multimorbidity requires a generalist understanding of illness, recognition of the role of social adversity and the treatment of illness as a uni...
Competing Interests: None declared.