Realistic medicine

Question 1

Please see extracts from ‘Realistic Medicine’ written by current chief medical officer for scotland, Dr Catherine Calderwood:

Answer 1

“In striving to provide relief from disability, illness and death, modern medicine may have overreached itself and is now causing hidden harm – or at best providing some care that is of lesser value. Doctors generally choose less treatment for themselves than they provide for their patients.”

“We must deliver healthcare that focuses on true value to the patient. Waste in healthcare should be assessed not in terms of what might be thrown away, but in interventions that don’t add value for patients. This includes avoiding unwarranted variation in clinical practice and resultant outcomes. Evidence-based guidelines developed for people with single diseases should not necessarily be extrapolated to the management of patients with multiple conditions, given the possibility that this may result in over-treatment and over-complex medication regimes.”

“We need to change the outdated “doctor knows best” culture to one where both parties can combine their expertise and be more comfortable in sharing the power and responsibility of decision-making. It requires system and organisational change to promote the required attitudes, roles and skills.”

Question 2

What are the aims of Realistic Medicine (2015)?

Answer 2

• Build a personalised approach to care
• Change our style to shared decision-making
• Reduce unnecessary variation in practice and outcomes
• Reduce harm and waste
• Manage risk better
• Become improvers and innovators

Question 3

What does the public think makes a good doc?

Answer 3

1. Knowledge/qualifications
2. Good listener
3. Friendly/approachable

Question 4

What does the public regard as important elements of a good consultation?

Answer 4

• Feel listened too/but not rushed
• Clear communication
• Resolution/Diagnosis/Outcome

Question 5

In what ways can we reduce unnecessary variation in practice?

Answer 5

• Guidelines

Question 6

In what ways can we reduce harm and waste?

Answer 6

• Reduce the amount of overdiagnosis
• For example when the hypertension threshold in USA was changed from 160 to 140, 13 million people became unhealthy - requiring hypertensive meds and the side effects that come with them

Question 7

How can we manage risk more effectively?

Answer 7

• GP’s in particular, are experts at managing risk, and Realistic Medicine embeds a set of principles for the NHS in Scotland, that to some extent, GP’s have been comfortable with for some time.
• Think about Hypothetico-Deductive reasoning - GP’s need to establish a set of working diagnoses without necessarily having every possible investigation available to them

Question 8

How can we become improvers and innovators?

Answer 8

• The emphasis on using data to support discussions and learning in clinical teams is already an established approach within general medical practice.
• We can improver and innovate through rEfLectIon

Question 9

What are the 5 questions ‘Choosing Wisely’ questions that patients can ask thier doctor or nurse?

Answer 9

• Is this test, treatment or procedure really necessary?
• What are the potential benefits or risks?
• What are the possible side effects?
• Are their simpler, safer or alternative treatment options?
• What would happen if I did nothing?