Advanced serious illness, multimorbidity, and multibeneficence: The role of communication

Sturmberg et al write about multimorbidity as “several diagnosable diseases within the same individual.”[1][Sturmberg JP, 2017] They posit that this syndrome is the result of multiple interconnected disturbances reflecting scale‐free, fractal signs of pathology ranging from biochemical/hormonal alterations at one end of a spectrum to community and societal ills at the other. In this commentary, I will be focusing on 3 perspectives: 1) a preterminal phase of multimorbidity that is indicative of that loss of reparative or even homeokinetic properties, known by some as “advanced serious illness”[2][, ]; 2) the manifestations of advanced serious illness multimorbidity that, using the same networks that connect into the patient, are signs of this syndrome at the levels of the immediate family/friend social network, the broader community, and society at large; and 3) the potential for these same networks that transmit pathological forces to convey the positive effects of therapeutic interventions in a scale‐free manner, with a focus on how conversation can lead to what I'm calling “multibeneficence.”