Dr Kieran Walsh is the Clinical Director at BMJ and previously trained in geriatric medicine.
I started training in geriatric medicine nearly 30 years ago and I still remember learning its core principles such as holistic care, interprofessional working, comprehensive assessment, frailty management and multimorbidity treatment. There were probably others as well, and perhaps I don’t remember them all as clearly as I should. One of my consultants gave particularly good advice. She said, “Don’t just follow guidelines blindly - see how well you can apply them to the patient in front of you.” It might have been a bit easier to practise back then – there were fewer guidelines and less pressure to stick to them rigidly.
As I approached the end of my training in geriatric medicine, I thought I would get involved in the emerging specialty of medical education and started working for BMJ on its evidence-based knowledge and learning resources. It was a big change, but I always tried to keep my geriatric training in the back of my mind. This was, and still is, important because evidence-based medicine and the application of evidence-based medicine should be inseparable. These concepts should be inseparable, but often they aren’t, and so people will sometimes say:
“Evidence-based medicine doesn’t work in the real world.”
There are lots of reasons for this, but one fundamental reason that underpins many others is that evidence is often built for people with single conditions, and so it is difficult to apply in patients with multiple conditions.
BMJ Best Practice is the clinical decision support resource of the BMJ1. It gives evidence-based, continuously updated and practical guidance to help healthcare professionals make better clinical decisions. It has traditionally focused on patients with single conditions, but more recently, we launched the BMJ Best Practice Comorbidities Manager to enable better decisions for patients with multiple conditions2.
One example might be a patient with an exacerbation of COPD who also has diabetes. This patient’s healthcare professional might look up how to manage the COPD on BMJ Best Practice. However, the healthcare professional will have the opportunity to add diabetes to the treatment algorithm. The algorithm is thus dynamic and gives guidance on how to manage both conditions together and thus provide holistic care to the patient.
All geriatricians know this; however, there will never be enough geriatricians to manage all patients with comorbidities. In any case, there is a considerable number of younger patients with multimorbidity. So, the challenge is to help all healthcare professionals provide holistic and patient-centred care to all people who need it.
BMJ Best Practice Comorbidities Manager is currently freely available to all healthcare professionals who work for the NHS in England, Scotland and Wales. It can support your practice and learning3. It provides the latest in digital health technology (from tagging and coding to info button integration into clinical systems), yet it is built on traditional principles of geriatric medicine that I learned many years ago. I hope that you find it helpful and that you can also help us spread the word about its availability in the NHS.
Find out more about how to access BMJ Best Practice for free here: bmj.com/nhse
