BMJ Best Practice Comorbidities – an essential tool for the on-call junior doctor

Author: Daniel Warrington, year 4 medical student, Manchester Medical School

What makes a good doctor? Surely, a good doctor is someone that is empathic, intelligent, and hard-working? These are all desirable traits, but another essential attribute of a doctor is to always have updated knowledge and skills to provide the best treatments for patients.  It is impossible to memorise every treatment algorithm, especially as they are constantly being updated, so I believe that a good doctor knows their limitations.

There are eleven major organ systems in the body and tens of thousands of ways that they can go wrong. We are not computers, and it is impossible for us to learn everything in medicine. New tools such as BMJ Best Practice Comorbidities mean that we can compile the expertise of lots of people into one easy reference source.

BMJ Best Practice has developed a new and unique tool to tackle the immense challenge of managing patients with comorbidities at the point of care. The BMJ Best Practice Comorbidities tool allows you to add a patient’s pre-existing comorbidities into its app when looking up treatment guidance for an acute condition. The tool produces a tailored management plan taking these into account. It is written by leading specialists and is easy to use as part of the already popular BMJ Best Practice app which you can download onto a smartphone.

As a medical student, I have become an expert at memorising and reciting management plans for everything from nosebleeds to cardiac arrests (and lots in between). This skill helps me pass my exams, where I am faced with one specific scenario to manage within eight minutes: it makes the prospect of being a doctor seem relatively straightforward.

However, I am doubtful that the patients I will face as a junior doctor will have classic exam-style presentations. In fact, the statistics speak for themselves: one in three adults suffer from multiple chronic conditions and one in three patients admitted to hospital as an emergency have five or more conditions.

Should we treat everyone with an acute presentation the same regardless of their comorbidities? Can a patient be viewed as separate from these comorbidities? We know that managing comorbidities in the acute setting leads to better care, better clinical outcomes, and shorter lengths of stay. In our medical school interviews, we all promised to become doctors because of our love of science and desire to help people. If that statement still stands, we must treat the whole patient rather than just their acute presentation.

BMJ Best Practice has successfully produced the first algorithms and checklists for patients with comorbidities, easily accessible on a smartphone. The Comorbidities Tool is user-friendly and offers a tailored management plan for patients who present acutely with pre-existing comorbidities. Though not as glamorous as the lifesaving interventions you perhaps envisaged performing as a doctor, using checklists and guidance throughout your career will save lives and improve care.