Learn how to approach the geriatric patient with multimorbidity and how to parse through and prioritize a mile-long problem list with Dr Josh Uy, master geriatrician at the University of Pennsylvania. We review different approaches to a clinic visit with a patient who takes fifteen daily medications with just as many chief complaints, all in a thirty minute (or less!) appointment time. We discuss what the term “multimorbidity” even means, how to ask about patient preferences and use them to inform the treatment plan, and what the evidence has to say about adjusting treatment goals of common conditions for individual patients. (Spoiler alert: It all depends on the patient, comorbid conditions and goals!)  Full show notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Producer: Nora Taranto MD  Writer:  Nora Taranto MD, Leah Witt MD  Infographic:  Leah Witt MD  Cover Art: Nora Taranto MD  Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Leah Witt MD, Paul Williams MD, FACP Editor: Matthew Watto MD, FACP; Clair Morgan Guest: Josh Uy MD Time Stamps 00:00 Pun, Intro, disclaimer, guest bio 04:30 Guest one-liner; Career advice;  Picks of the Week*: Unbroken (book), Down Dog Yoga (app); Check out Dimash’s music on YouTube; Off Your Rocker (TV show); Finishing Well to the Glory of God (book) 12:30 A case of multimorbidity; Where to start? 15:30 How to focus the visit; Lumping and the problem list; 18:20 Dr Uy’s framework for multimorbidity 28:08 Questions (scripts) for eliciting patient preferences 30:20 Hypertension; All cause mortality; Number needed to treat; The danger of adding blood pressure medications in the hospital, the Jenga analogy 35:30 How to frame  potentially ineffective treatments (e.g. statins for primary prevention of stroke) and align treatments with a patient and family’s goals 44:18 Dr Uy runs through common comorbid conditions and time to benefit starting with longevity minded (45:43); Palliative minded approach (47:50) 48:49 Afib, anticoagulation and falls; Cancer screening 54:30 Take Home Points *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will develop an approach to managing older adults with multimorbidity in primary care   Learning objectives  After listening to this episode listeners will...  Define multimorbidity and its implications for triaging multiple chief complaints and chronic conditions Recognize the time frame to benefit of treatments for several chronic conditions Learn to ask patients about health care values and goals of care in order to optimize shared decision-making Identify the barriers to treating multimorbidity and strategize approaches for optimal primary care delivery for patients with multimorbidity Disclosures Dr Uy reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Uy J, Taranto N, Witt LJ, Williams PN, Brigham SK, Watto MF. “#181 The Multimorbidity Games”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 4, 2019.