You may have heard the word “comorbidity” before, but do you know what it means? Comorbidity refers to the presence of more than one disease or disease process in the human body. Derived from the word “morbid” the term suggests a seriousness that may not always be considered. Yet as the population ages, comorbidities increase. A study conducted in 2011 found that the average person, age 65 years or older, had been diagnosed with no less than 8.7 chronic diseases.[1]
To explore what “comorbidities” mean for patients, Medivizor spoke with Dr. Wanja Wolters, an orthopedic and trauma surgeon at the renowned University Clinic of Eppendorf in Hamburg, Germany. Dr. Wolters background includes four years practicing in one of Germany’s top infectious disease wards, treating patients with multiple comorbidities on a daily basis,
Medivizor: Dr. Wolters, How do you explain to a patient what comorbidity means? What are common comorbidities?
Dr. Wolters: Comorbidities, from a physician’s point of view, include all medical conditions besides the main diagnosis, which is currently treated. In my field (orthopedic surgery), for example, a patient can have a fracture of the hip (main diagnosis) with diabetes and high blood pressure (comorbidities). The comorbidities in our example affect the outcome of the treatment of the main diagnosis. Diabetes could trigger postoperative complications such as infection of the wound.
Common comorbidities cover all disciplines of medicine, mostly chronic internal diseases like high blood pressure, coronary heart disease, diabetes, all sorts of cancer, chronic obstructive lung disease, or asthma. But comorbidities also include conditions like allergies, obesity, abuse of alcohol, nicotine, or drugs, or even psychiatric diagnosis like dementia or Parkinsons disease.
M: What are the challenges for you at the clinic when treating patients with more than one (chronic) illness?
Dr. Wolters:: Surgeons face numerous problems in our patients with multiple comorbidities. They all can lead to complications during or after a surgical procedure. Often patients are treated with anticoagulant drugs (editor’s note: also known as blood thinner drugs) because of an underlying cardiac disease or stroke. This leads to increased bleeding during surgery and can be fatal. Not only comorbidities themselves but also different medications to treat chronic conditions can be an important risk factor during treatment. This includes drug interactions and allergic reactions, or other adverse events, as I mentioned earlier.
In daily clinical work in Emergency Room, hospital ward, and Operating Room, it is essential to learn as much as possible about a patient’s history, conditions, and medication. Sometimes this has to be completed in a very short period of time before a procedure. In these cases, we try to work very closely with other medical disciplines like internal medicine or neurology to decrease the risks for the patient as much as possible.
M: What are the risks for these patients at home?
Dr. Wolters: When being at home, there is no constant overview over vital parameters or bloodwork, so complications can arise undetected. A lot of patients don’t see their general practitioner regularly and often don’t even know about all their diseases and conditions. The drug therapy can be confusing with growing numbers of different prescriptions so that mix-ups or false dosage may occur. That is exactly why patients with comorbidities need constant contact with their general practitioner, especially after surgical procedures.
M: What do you consider especially important in the treatment of patients with comorbidities in private practice?
Dr. Wolters: As already mentioned, physicians in private practices continue and supervise the work we began during the acute treatment in the hospitals. They have often known their patients for years and have a vast knowledge of their comorbidities and complications. This makes them extremely important partners and sources of information for in-hospital physicians.
The overview of a patients’ history and the diseases and treatments in all the different specialties should be generated by a physician in private practice as they manageoverall treatment.
On the downside, private practices may not have the diagnostic and therapeutic tools of a fully equipped hospital. So, especially in the treatment of rare diseases or in cases of time consuming examinations, private practices may have difficulties
M: What can the patients actively do to positively impact their state in the clinic and at home?
Dr. Wolters: Remarkably, this is a question almost all patients ask. The answer will almost always be the same whatever physician you ask:
1)Patients should try to live healthy, eat diversified and fresh;
2)most patients could lose some weight,
3) discard bad habits like drinking and smoking,
4) start being active,
5) try to live fulfilled with family and friends,
6) take your medication as prescribed,
7) see your doctor regularly and do as he suggests.
M: Thank you so much for taking the time to speak to us, Dr.Wolters.
Dr. Wolters: The pleasure was all mine.
[1] Davis JW, Chung R, Juarez DT. Prevalence of comorbid conditions with aging among patients with diabetes and cardiovascular disease. Hawaii Med J. 2011 Oct;70(10):209-13. PMID: 22162595; PMCID: PMC3215980.
