Cambridge University Hospital: Treating patients with comorbidities

Dr Forsyth discusses treating patients with comorbidities using BMJ Best Practice.

By Dr Duncan Forsyth
Sep 08, 2021

The careful and complicated balancing act of treating patients with comorbidities

Duncan Forsyth is a Consultant Geriatrician at Cambridge University Hospital’s, Addenbrooke’s Hospital. He runs a specialist delirium ward in the Department of Medicine for the Elderly and a nationally respected Parkinson’s disease service.

In this interview, Duncan explains how the BMJ Best Practice Comorbidities tool can be used in geriatric medicine to help junior doctors manage patients with multiple complex conditions.

“Geriatric medicine is the medicine of frailty, predominantly in older age. The patients I see typically live with several comorbidities. Inevitably, the more conditions a patient has, the more likely they are to be taking multiple drugs to treat each of those conditions. They may be on hypoglycaemic agents for diabetes, inhalers for chronic obstructive pulmonary disease (COPD) and antihypertensives or possibly diuretics for heart failure and oral anticoagulants if they have atrial fibrillation. Many of my patients are also living with dementia.”

"I tested the list of comorbidities detailed on BMJ Best Practice Comorbidities against some of my patients on the ward. In doing so I was able to conclude that the list of comorbidities was highly appropriate and very well crafted. The list selected both the most prevalent and challenging comorbidities in terms of drug interactions for acute and pre-existing conditions."

Dr Duncan Forsyth, Consultant Geriatrician at Cambridge University Hospital’s, Addenbrooke’s Hospital.

“Treating these patients is a careful and complicated balancing act between the medication they were taking before they were hospitalised and the possible interactions that any new treatments may have. Geriatricians like myself will often be heard saying, ‘these guidelines are great, but have been generated for people who don’t have multiple comorbidities.'”

“The average age of patients on my ward is 85. However age doesn’t define how you will respond to treatment but frailty and your comorbidities do.”

“I tested the list of comorbidities detailed on BMJ Best Practice Comorbidities against some of
my patients on the ward. In doing so I was able to conclude that the list of comorbidities was highly appropriate and very well crafted. The list selected both the most prevalent and challenging
comorbidities in terms of drug interactions for acute and pre-existing conditions.”

“During a ward round, a number of my trainees will say they are not very familiar with a particular condition or its management, and may resort to ‘Dr Google’. Where BMJ Best Practice Comorbidities really trumps other resources and guidelines is that it considers comorbidities.”

Dr Duncan Forsyth, Consultant Geriatrician at Cambridge University Hospital’s, Addenbrooke’s Hospital.

Using BMJ Best Practice to reinforce junior doctors’ knowledge

“In testing the topic on COPD, I added diabetes and dementia, two very common comorbidities. How the addition of these two comorbidities changed the advice regarding the management of an acute exacerbation of COPD was sensible, accurate and helpful. I also tested the module by adding other co-morbidities and again found the advice regarding how this might alter management helpful.”

“While a consultant like myself may find this tool helpful, it’s more suitable for those with less experience and has the ability to help them through the complexities of geriatric medicine. I enlisted two trainees, both at different stages in their career, to review BMJ Best Practice Comorbidities.”

“The first was a foundation year trainee, at the very start of their career, and the second was more senior and in the process of changing career from a subspecialty surgical pathway. While senior in their previous career, this person needed to be quickly immersed into the complexities of geriatric and general medicine.”

“Both trainees found the tool helpful. We all agreed the content was well-structured and provided useful learning. In reviewing this resource, we mixed and matched the comorbidities. Each time it was clear what changes to management came about from the comorbidities the patient had.”

“During a ward round, a number of my trainees will say they are not very familiar with a particular condition or its management, and may resort to ‘Dr Google’. Where BMJ Best Practice Comorbidities really trumps other resources and guidelines is that it considers comorbidities.”

“It can be used to help reinforce junior doctors’ knowledge on the ward, while expanding on what they didn’t know.”

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