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Treating the person not the condition

The importance of treating the patient not the condition has been brought into sharp focus by a Cambridge University study published in the British Journal of General Practice. Reviewing the health records of more than 400,000 adults, the study revealed that 30% of females and 24.4% of males were suffering from more than one health condition, otherwise known as multimorbidity. Moreover, those who reported experiencing more than one health condition accounted for 52.9% of GP consultations and 78.7% of prescriptions.


Breaking down the statistics by underlying cause, the most prevalent conditions according to the report were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). Interestingly, those aged between eighteen and forty-four or having been identified as having lower socio-economic status were more likely to report a combination of physical and mental conditions.


Whilst the findings may not come as a huge surprise to health professionals, nevertheless they do serve to highlight the way in which individual conditions should not be treated in isolation. As the report’s authors highlight “multimorbidity has a substantial impact on various health services ranging from general practice to end-of-life care.” Moreover, gaining a better understanding of the complex relationships between conditions could help the health service in general to target resources appropriately. As Dr Duncan Edwards, one of the authors commented “It may be that we need to think about a drastic restructuring of services: no longer will people be seen in ‘single disease’ services but in new multimorbidity clinics designed for the future.”


Where does this leave health professionals in the meantime? For some, it may simply a question of heightening awareness rather than changing practices. For example, physiotherapists, osteopaths and chiropractors are well used to thinking holistically when treating muscle and ligament pain. That’s because carrying the body differently in response to an injury is very likely to lead to referred pain or contribute to additional musculoskeletal damage.


Where the challenge becomes more complex is when it crosses disciplines; for example where obesity gives rise to a range of conditions including chronic pain, hypertension, diabetes and depression. In these instances whilst the potential causal link may be understood, care may be provided by a number of health specialists. Not only does this condemn the patient to multiple doctor and hospital appointments, a delay in treating one aspect of the condition may contribute negatively to the chance of recovery in other areas.


The five-year forward review of health practices in the UK had already identified the need for treating patients holistically. This study sheds further light on the reasoning behind that review as well as calling into question the current structure of health services within this country. Treating the condition in isolation may not restore the patient to full health and could even lead to further complications. As Professor Helen Stokes-Lampard, Chairman of the Royal College of GPs, commented: “This large-scale, comprehensive research is further evidence of the increasing complexity of cases that GPs are dealing with, and the inadequacy of the standard 10-minute consultation.”


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