CCFP 105 Topics: Multiple Medical Problems

• Written By:
  • Vaishvi Patel, a fourth-year medical student from the University of Alberta
  • Ronan Noble an MD/PhD student also from the University of Alberta
• Expert Review By:
  • Dr. Henry Ma, PGY2 FM at UofA

Objectives:

1. In all patients presenting with multiple medical concerns (e.g., complaints, problems, diagnoses), take an appropriate history to determine the primary reason for the consultation.

• In all patients presenting with multiple medical concerns, prioritize problems appropriately to develop an agenda that both you and the patient can agree upon (i.e., determine common ground).

• In a patient with multiple medical complaints (and/or visits), consider underlying depression, anxiety, or abuse (e.g., physical, medication, or drug abuse) as the cause of the symptoms, while continuing to search for other organic pathology.

• Periodically re-address and re-evaluate the management of patients with multiple medical problems in order to:

• simplify their management (pharmacologic and other)

• limit polypharmacy

• minimize possible drug interactions

• update therapeutic choices (e.g., because of changing guidelines or the patient's situation)

• In patients with multiple medical problems and recurrent visits for unchanging symptoms, set limits for consultations when appropriate (e.g., limit the duration and frequency of visits).