Frances Mair and I have an Editorial in this week’s British Medical Journal that sets out some of the key problems around Burden of Treatment and multi-morbidity. That the BMJ should commission this editorial from us shows that the idea of Burden of Treatment is getting traction across the healthcare economy. And why shouldn’t it? The bug issue here is patient and carer workload – something that we know much less about than we should. The editorial comes hot on the heels of an important meeting sponsored jointly by the National Institute of Health Research and the Royal College of General Practitioners that sought to develop a strong research agenda on multi-morbidity. The key message that I took away from that meeting was that there was a real risk of turning multi-morbidity into a kind of new disease in itself – in the way that we often now hear chronic illness and long-term conditions spoken about in a quite undifferentiated way. In fact, the big problems here are at a system level, and they’re the problems that Frances and I discuss in our editorial. I was a plenary speaker at the RCGP NIHR Multimorbidity meeting and I’ve embedded my powerpoint presentation below.
Multimorbidity, Burden of Treatment and Intervention Design from Carl May
Great job, Carl and Frances!
This is excellent: “Can you really do what I’m asking you to do?”
Now what we need to articulate is, how do we respond when the answer is ‘no’ ?
I think this concept is incredibly important.
Each specialty adds complexity to the burden of patients AND struggling primary care providers. Granted, it is most important that PATIENTS have “capacity” for their care and have choice and ultimate say in what they do. But they often (in my experience) ask us, as primary care providers “how they are doing”. And then I notice that each specialty seems surprised that primary care can’t/doesn’t succeed: and the message to providers is “you are failing”. When what is really failing is our ability to accept that a lot of patients (most?) don’t CARE about all the little unproven tests and treatments dictated to them. And that doesn’t even begin to touch on how we fail to do the unproven follow-up on the unproven initial abnormal tests that overdiagnose. Just my 2 cents. Thank you for re-posting!
Mark
Treatment Burden and it’s impact on the patient, relational network & social/healthcare systems is incredibly timely and foundational. In America, we have seen recently how the Veteran’s Administration medical centers have been overwhelmed by the organizational issues precipitated by the additional needs of Iraq/Afghanistan veterans and the multimorbidity of the “signature” problem of that war; PTSD with traumatic brain injury, substance abuse and various configurations of mood disorders, anxiety, family/relationship problems, employment problems, etc. The complexities of negotiating the institutional maze, repairing relationships, and illness recovery while handicapped by hypervigilence, insomnia, affective dysregulation and general limbic overload make day-to-day life a living hell. Your reconceptualization of multimorbidity as a new entity (and epidemic) makes sense. The social, behavioral, psychopathological changes resulting from the multimorbidity and functioning in this environment changes narrative identities and subsequent beliefs, expectations, choices and consequences. In other words, coping with the allostatic load produces a synergistic interaction and a novel disorder results; a condition that is decidedly not the sum of the parts of multiple morbidities.