Caring with patients with multimorbidity in systems classically built for single diseases...
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Caring with patients with multimorbidity in systems classically built for single diseases...
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Hi all, I was wondering what everyone thought about caring for patients with multimorbidity in healthcare systems (here in the UK but also across the world) classically built for dealing with s
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Caring with patients with multimorbidity in systems classically built for single diseases...
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Caring with patients with multimorbidity in systems classically built for single diseases...
posted at 19/1/2012 6:27 PM GMT
on bmj.com
Moved from the General forum
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Posts: 24
First: 19/1/2012 Last: 18/4/2012 |
Hi all, I was wondering what everyone thought about caring for patients with multimorbidity in healthcare systems (here in the UK but also across the world) classically built for dealing with single diseases? - What are the possible solutions? From my point of view, as a psychiatrist, one major problem for my patients in the interface between medicine and psychiatry. We know people with a severe mental illness will have higher rates of all sorts of physical illnesses, and that treatment is accessed and received differently: The fact mental health trusts in the UK are all separate organisations and often on completely different hospital sites to other specialities doesn't really help this I don't think. It doesn't help our psychiatric patients get medical care, as facilities like x-ray machines and ITUs, as well as medical expertise, are not immediately onsite. It also means we as psychiatrists often feel quite disjointed from the rest of medicine, we can't easily pop to the mess and get some informal advice! I'm sure there are medics out there who feel we psychiatrists are a bit far away and hard to get hold of sometimes too, when people on medical or surgical wards have a mental health problem. A recent report on crisis and acute mental health services by a major UK mental health charity, Mind, called 'Listening to Experience' suggests that the move to shift psychiatry wards to general hospital sites should be stopped, although it also suggests improving the availability of liaison (consultation) psychiatry services (which aren't by any means available in all hospitals in the UK). I would be really interested to know what people think of the report. It is a really interesting and worthwhile read, and can be downloaded at: |
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Re: Caring with patients with multimorbidity in systems classically built for single diseases...
posted at 19/1/2012 7:14 PM GMT
on bmj.com
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Posts: 371
First: 13/4/2011 Last: 21/5/2012 |
Hello Alice: Nice having a shrink posting interesting questions to clinicians. I do not like mental institutions for treating people (And enjoyed a lot Martin Scorcese´s movie). One only Hospital for all kind of diseased people looks to me as the best model for hospitalized people. An interesting recent article poses in another way this issue: "THE TREATMENT OF UNRELATED DISORDERS IN PATIENTS WITH CHRONIC MEDICAL DISEASES". All Best, Joey
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Re: Caring with patients with multimorbidity in systems classically built for single diseases...
posted at 21/1/2012 3:21 PM GMT
on bmj.com
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Posts: 148
First: 29/4/2011 Last: 18/5/2012 |
Nicely stated Alice. It makes no sense to me to separate intellectually or physically the physicians and facilities for the treatment of physical and emotional disabilities. As a specialist in diabetes I come across people whose ability to apply complex self-care behaviors on a day-to-day basis is severely limited by depression or anxiety. The prevalence of depression in diabetes (and other chronic diseases) is generally 20% and the lifetime incidence approaches 100%. We desperately need your expertise in the development and application of therapies in our care of patients. |
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Re: Caring with patients with multimorbidity in systems classically built for single diseases...
posted at 21/1/2012 5:10 PM GMT
on bmj.com
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Posts: 152
First: 17/12/2011 Last: 20/5/2012 |
I think I have a bit more reading to do. I will read this article. I must ask one of my younger partners how you attach article so that it can be accessed by clicking on it, the mind report is 52 pages long so I think I wont print that on out! As an inner City GP I certainly see the the interaction of Physical and Mental Health. Some of my chronically ill mentally ill patients were ,I think, as well looked after in the local mental hospital [now closed down] as they are in the 'community', they tend to be in large 'bed and breakfast' inner city accommodation'. Long term oral and antipsychotics have enabled community care, but I would like more psychiatric beds for the crises that do still occur. It would be good to have more detox beds for alcohol and drug addictoion 'drying out ' and to give people an oppertunity to change . UK GPs are being encouraged to do 'health checks' on psychiatric patients. I am not entirley convinced that this is of great benifit to the patients concerned. I think Psychiatrists need to be on site in District General Hospitals. As nearly all disease has some psychiatric component . Mind you I would also like every District General Hospital to have a General Physician. So I am probably very old fashioned. |
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Re: Caring with patients with multimorbidity in systems classically built for single diseases...
posted at 24/1/2012 12:38 PM GMT
on bmj.com
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Posts: 3
First: 13/11/2009 Last: 24/1/2012 |
Here, in Spain, psychiatric hospitalisation occurs in general hospitals, with a perfect integration of care at that level. This isn't so in primary care, where specialised mental health care is offered appart from primary health centres, and even appart from ambulatory specialised care for other diseases. Although integration of care is a matter of concern now, the Spanish health reform in 1980's spoke about comprehensiveness, integrality, accesibility, continuity... Primary care doctors compromised with these values, but they have been overwhelmed by assistance, and nurses haven't assumed their role in this realm. So, now, health administrators speak and speak on integrality, such as they had discovered now the item. And nurses try to get a leadership that they haven't gained during years. |
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Re: Caring with patients with multimorbidity in systems classically built for single diseases...
posted at 24/1/2012 12:51 PM GMT
on bmj.com
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Posts: 371
First: 13/4/2011 Last: 21/5/2012 |
Hello All: It seems to me that it would be wonderful seeing psychiatric doctors using their sthetoscopes. ordering common lab tests, and examining ECGs. Am I delusional, wondering this? The patients would say: Thank you Sir!!! All Best, Joey
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Re: Caring with patients with multimorbidity in systems classically built for single diseases...
posted at 29/1/2012 11:55 AM GMT
on bmj.com
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Posts: 24
First: 19/1/2012 Last: 18/4/2012 |
I order lab tests, do still use a stethoscope and think I still could read an ECG... Very true though Joey - as I get more senior in psychiatry I worry my medical skills are slipping away and becoming out of date. The Royal College of Psychiatrists does a good series of courses on updating medical knowledge for psychiatrists: http://www.rcpsych.ac.uk/training/cetchome.aspx |
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