Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016 appendix

NHS Lothian

Initial thoughts

A strength of the CMO's articulation of Realistic Medicine is familiarity. At its best, Realistic Medicine describes high quality, person-centred clinical care with genuine shared, informed decision making. Hence many of our colleagues have recognised Realistic Medicine as something they are already doing and would like to do more.

What have we done so far?

A number of initiatives in NHS Lothian are directly reflective of the Realistic Medicine principles. In addition to the conservative clinic for renal disease discussed earlier, patients with Urological disease potentially requiring surgery now have an enhanced multidisciplinary admission review by medical Consultants in MOE, Anaesthetics and Urology to identify frailer patients in whom the benefits of surgery may outweigh risks. This leads to an enhanced pre-operative counselling and preparation process to facilitate shared decision making and informed consent for elective urological procedures.

Oncology MDTs are well-established forums for clinical decision making. However they are prototyping enhanced services to bring patients further into the options appraisal process before a final 'best treatment' recommendation is made by the MDT. This specifically includes discussing the benefits as well as risks of 'no' or 'minimal' treatment.

What next?

Care guidelines for Renal referrals are being developed including strong links with GPs including advice on asymptomatic low eGFR. The Clinical Change Forum pre-dates Realistic Medicine however the renal unit experience was recently presented there and this will continue to be developed. The oncology MDT service continues to be developed and will now expand beyond the pilot service.

Final thoughts

In reality, patients are often more realistic than we are. It is essential to consider the care we provide in a pragmatic and holistic way - to the benefit of the people we look after.

Alistair's Story': A patient shares his story of shared decision making in his treatment at the renal conservative care clinic.