Realistic medicine Flashcards
What are aims of realistic medicine?
Build a personal approach to care
Change our style to shared decision-making
Reduce unnecessary variation in practice outcomes
Reduce harm and waste
Manage risk better
Become improvers and innovators
What is involved in personalised care?
Think of the information the patient needs
Think of patient centred care
Think of how to show the patient risk
Actual risk reduction vs relative risk reduction
Think if that will help them decide
Think of where the patient is in cycle of change
Does he NEED treatment
What is involved in changing our style to shared decision making?
Consider what patient’s want to see in a doctor
Consider what patient’s want in their consultation
Think of how comfortable patient’s feel asking difficult question
What is a Citizen’s Panel?
A large, demographically representative group of citizens regularly used to assess public preferences and opinions
What do people feel makes a good doctor?
Knowledge/qualifications
Good listener
Friendly/approachable
What do people feel are the most important elements of a good consultation with a doctor?
Feel listened to and not being rushed
Clear communication
Resolution/diagnosis/outcome
How can we reduce unnecessary variation in practice?
Use guidelines
What is the main cause of harm and waste?
Overdiagnosis
What conditions are commonly overdiagnosed?
Prostate cancer Thyroid cancer Asthma Chronic kidney disease ADHD
What generally causes overdiagnosis?
Clinical findings in asymptomatic people
What are issues for patients who feel healthy but are diagnosed with a condition such as hypertension?
Exposed to drug induced problems such as kidney injury, etc
Holiday insurance will change as well as ability to gain a mortgage
Contraindications for some medications
Worrying about higher risk ie of stroke in hypertension
What can we do to become improvers and innovators?
Use data from other practitioners - Scottish Intensive Care Society Audit Group
Reflection
What is involved in reflection?
Identify an issue that has gone well or not so well
Consider emotions and the issue itself
Propose an improved way forward for the future
What are 5 questions to prompt better conversations between clinicians and patients?
Is this test, treatment, or procedure really needed?
What are the potential benefits or risks?
What are the possible side effects?
Are there simpler, safer, or alternative treatment options?
What would happen if I did nothing?
