A 74 year woman presents to the office for a new patient visit. She has hypertension, type 2 diabetes mellitus, polymyalgia rheumatica (PMR), anxiety, episodic alcohol abuse, depression, and obesity. Her LDL cholesterol is 130. How should the physician manage her cholesterol?
There are no evidence based, treatment guidelines available to answer this question.
Wait a minute: what about the recently released, ACC guidelines on cholesterol management? Shouldn’t she be placed on a statin?
Patients with multimorbidity raise multiple questions for clinicians: do the ACC guidelines and scientific evidence apply to this patient? Do the benefits of statins outweigh the risks? Will statins worsen this woman’s myalgias and quality of life? Will they accelerate liver disease in an obese, alcohol user? Impair her cognition? What does the patient want to do?
Again, there are no treatment guidelines available that take into account the complexity of this patient’s multiple medical problems, nor address her preferences for treatment.1
How to resolve the dilemma?
Talk to the patient.
–Dean Gianakos, MD, FACP
Dean Gianakos, MD, FACP, practices and teaches general internal medicine in the Lynchburg Family Medicine Residency and Geriatrics Fellowship, Lynchburg, VA. He frequently writes and lectures on the patient-physician relationship, end-of-life care, and the medical humanities.
References
- Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 2012; 1-25.
