Response to Comorbidification Dilemma

(Alright, here comes the representative 'current or future internist'...)

This is a very good article, in that it brings to the attention of NYTimes readers something that is being discussed all the time in academic centers. While I like to think that we're all aware of our patients' comorbidities, that's clearly not true. Being an internist, it's particularly disconcertnig to notice how various specialists' notes don't reference the OTHER specialists (and that's where, as the article references, everyone needs a 'coach' to keep the team together...that coach being ideally the internist rather than the patient).

And this is where geriatricians have got it right. Like the article said, "What is best for the disease may not be best for the patient." I remember coming across this idea really well demonstrated in a great article by Atul Gawande (yes, another Atul Gawande article): The Way We Age Now.

But that's easier said than done. Are you really not going to anticoagulate that elder patient with unsteady balance when the literature says you should? Ideally we internists should develop the sort of relationship with our patients where we can explain the risks and benefits of our medical decisions to patients so that we're not terrified of getting sued on those occasions when we go against 'The Recommendations'. But that would require a whole lot more than 15 minutes every few months.

So what's the answer? Probably more time with patients, more streamlined computer records (come on, stimulus package!... see NEJM article this week on 'Stimulating the Adoption of Information Technology'). That way we can see the whole person and tailor our treatment accordingly.

Speaking of which...my 4:30 patient just arrived in the waiting room, wouldn't want blogging to cut in on precious patient time...