How do I manage complex patients on many medications?

You manage most therapy well now, so trust that ground. The complex, many-drug patients trip you because the interactions multiply faster than anyone can hold in their head. That is not a gap in you. It is the true difficulty of the problem. These cases are not solved by knowing more facts. They are solved by working slowly and systematically: one drug at a time, each interaction checked, the whole picture laid out where you can see it. Speed is the enemy here. Method is the friend. With your next complex patient, write out every medication in a single list and go down it line by line, asking what each one does to the others. Seeing it on paper turns an overwhelming tangle into a set of questions you can answer.