Realistic Medicine

Realistic Medicine was a concept first proposed by Scotland’s Chief Medical Officer Cath Calderwood in her annual report for 2014-15 which was published in 2016. Realistic Medicine puts the person receiving care at the centre of decision-making and creates a supported, personalised approach. It aims to reduce harm, waste and unwarranted variation, whilst acknowledging and managing the inherent risks associated with all healthcare. It also champions innovation and improvement. To achieve this, people using healthcare services and their families must feel empowered to discuss their treatment fully with healthcare professionals, in language that they will understand. This should include any possibility that a suggested treatment might come with side effects – or even negative outcomes. Realistic Medicine is an attempt to move away from the “Doctor knows best” approach to shared decision making and the co-production of care.

Realistic Medicine has a particular ethos which involves;

  • Listening to understand patients problems and preferences;
  • Sharing decision making between healthcare professionals and their patients;
  • Ensuring that patients have all the understandable information they need to make an informed choice;
  • Supporting healthcare professionals to be innovative, to pursue continuous quality improvement and to manage risk better;
  • Reducing the harm and waste caused by both over-provision and under-provision of care;
  • Identifying and reducing unwarranted variation in clinical practices.

Realistic Medicine is not about rationing healthcare or saving money. It’s aim is to improve patient care; ensuring that people receive appropriate and beneficial care that is evidence-based and in tune with their personal preferences.

To deliver Realistic Medicine everyone should feel able to ask their healthcare professional why they’ve suggested a test, treatment or procedure, and all decisions about a person’s care should be made jointly between the individual and their healthcare team. One of the early initiatives from Realistic Medicine was to encourage everyone to ask 5 questions

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

Every healthcare professional should be able to answer these questions for all treatments and procedures they suggest. When people ask these questions they are more likely to receive healthcare suited to their needs that they also be more likely to comply with.

Since its adoption in 2016 the CMO for Scotland has continued to write about Realsitic Medicine and what it involves. Her 2017 report was called Realising Realistic Medicine, the 2018 report was called Practising Realistic Medicine and the most recent 2019 report was called Personalising Realistic Medicine. Last year also saw the introduction of a new comprehensive Realistic Medicine website which you can explore HERE

This video made by Healthcare Improvement Scotland talks to members of the public about realistic medicine and asked them what mattered most to them.

With regards to Fraily

In relation to Realistic Medicine and Frailty, the Director of Public Health for NHS Highland in his Annual Report in 2017 highlighted the following key points:

  • To reduce frailty we need to promote interventions that improve physical functioning by increasing muscle mass and strength, particularly progressive resistance strength training, exercise involving gait, balance, co-ordination, and encourage walking on a daily basis.
  • The effectiveness of dietary interventions are subject to more uncertainty but a healthy diet is important in preventing and addressing frailty.
  • A life-course approach to optimising peak muscle mass and strength in early life, maintaining this in adulthood, and reducing the rate of loss in older adulthood would be a useful strategy for reducing the rate of frailty across our population.
  • For hospitalised patients, better outcomes are associated with care delivered by older people’s multi-disciplinary teams, particularly when these are delivered in designated units or wards.
  • Interventions that reduce hospitalisation include certain types of nurse-led units, tele-health care for long-term conditions, discharge planning from hospital to home, case management in heart failure and integration where more generic case management is utilised would help keep more people in their own homes, where they want to be .
  • We need to maximise the network of support around every frail person so that they have the right support to improve their health, manage their condition and maintain their independence.

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