DÄ internationalArchive28-29/2011Multimorbidity as a Dilemma
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I completely agree with the authors’ conclusion, that therapeutic decisions are based on “other practice-relevant factors”; however, this is with regard to guidelines and NOT to “clinical data.”

The authors mention “internal organizational routines of the physician’s office” first, then “financial parameters,”, with “patient-related aspects” mentioned last. The fact that they recommend “to implement guideline recommendations as in-process control variables in standardized software” is consistent with this.

From my perspective as a general practitioner the practice relevant factors are weighted in exactly the opposite order: patient-related aspects come first.

The most important aspect that hinders guideline-conform treatment is patients’ multimorbidities. These consist of many clinical data.

The second is people’s insistent adherence to their own habits, and the slight unease that most people develop when they have to take more than three tablets a day.

This is an obstacle to guideline-conform treatment of hypertension, which—as is well known— patients themselves do not notice .

I would ask to be spared further bureaucratization (“to implement guideline recommendations as in-process control variables in standardized software”). In my opinion it would make sense to set out overriding guidelines for how to deal with patients with multimorbidities. Geriatric medicine provides a good example in this context. Medical pr

actice based on geriatric principles often leads to minimalizing the instructions from other guidelines. For the individual physician faced with the dilemma of multimorbidity this provides substantial relief.

DOI: 10.3238/arztebl.2011.0492b

Dr. med. Julia Beller

Weilheim, Germany

jubelokt@aol.com

Conflict of interest statement
The author declares that no conflict of interest exists.

1.
Karbach U, Schubert I, Hagemeister J, Ernstmann N, Pfaff H, Höpp HW: Physicians’ knowledge of and compliance with guidelines: an exploratory study in cardiovascular diseases. Dtsch Arztebl Int 2011; 108(5): 61–9. VOLLTEXT
1.Karbach U, Schubert I, Hagemeister J, Ernstmann N, Pfaff H, Höpp HW: Physicians’ knowledge of and compliance with guidelines: an exploratory study in cardiovascular diseases. Dtsch Arztebl Int 2011; 108(5): 61–9. VOLLTEXT