Realistic MedicineDr Catherine Calderwood

Chief Medical Officer for Scotland,obstetrician and gynaecologist

Feedback so far….

Realistic Medicine• Added Value of Doctors in a complex system• Realism in Healthcare• Sharing Decision-making and Informing Consent:

People and Professionals combining their expertise• Doctors and the Management of Clinical Risk• Changing Practice to Support Improvement• Translation of Medical Research into Routine

Clinical Practice

Added Value of Doctors in a Complex System

• Current models of healthcare are stretched

• This doesn’t always suit patients, the people who care for them or the aspirations of workforce

• Good clinical leadership linked to good patient care

• Strong clinical leadership single most effective force to prevent failings in future

Realism in Healthcare

• Doctors generally choose less treatment for themselves than for patients• Striving to provide relief from disability, illness and death, modern medicine may

have overreached itself – is it now causing hidden harm?• Focus on patient – unwarranted variation in clinical practice and outcomes?• Multiple conditions – management leading to over-complex medical regimes?• Clinicians have duty to acknowledge powerlessness at times – difficulty on our

part should not affect patient’s experience of end of life.

Sharing Decision-making and Informing Consent: People and Professionals combining their expertise

• Leave behind “doctor knows best”• Shared power and responsibility of decision-making• Requires system and organisational change to promote required attitude, roles and skills• House of care is useful representation:

Scotland’s House of Care

Doctors and the Management of Clinical Risk

• Managing risk in healthcare is universal challenge• Robust decisions against accusations of being paternalistic• Risk with every clinical decision• No substitute for clinical experience• Sign of burn out is reduced ability to tolerate anxiety of

making risky decisions• Good risk management dependent on communication of

risk with other services

Changing our Practice to Support Improvement

From Lucas, B & Nacer, H (2015) The habits of an improver. Thinking about learning for improvement in healthcare. London: The Health Foundation page 8

Translation of Medical Research into Routine Clinical Practice

• Translation of research into clinical practice has transformed healthcare

• The route to translation can be challenging: high costs, shortages in key research infrastructure, capacity or capabilities, slow/ incomplete recruitment to trials

• How do we ensure research can more effectively translate to improved patient care?

Your feedback will help shape policy…..

https://www.surveymonkey.co.uk/r/LMDCMWM

cmo@gov.scot

0131-244 2379

@cathcalderwood1

https://uk.linkedin.com/pub/catherine-calderwood/108/979/691

http://blogs.scotland.gov.uk/cmo/