Multiple Medical Problems

Many patients present to the family medicine clinic with multiple medical problems. It is important to have an approach when dealing with these patients as they can often be difficult. In these patients it is important to address their concerns, screen for underlying psychiatric diagnosis, and set appropriate boundaries.

General Approach

 * 1) Take relevant history (may take multiple visits)
 * 2) Determine primary reason for consultation
 * 3) Prioritize problems. Important to set agenda to establish common ground.
 * 4) Rule out organic causes. At the same time screen and consider underlying psychiatric disorders (e.g. depression, anxiety, somatization, substance use, abuse)
 * 5) Note: patients with multiple medical problems are at increased risk for secondary depression therefore important to periodically screen
 * 6) Re-evaluate management plans (simplify management, limit polypharmacy)
 * 7) Ensure close follow-up while setting limits and boundaries to each visit

See other pages including: Difficult patient, Somatization