Global healthcare successes in assisting people to live longer have also brought about new challenges, such as older people living with multiple conditions and additional complexity, both in their experience of illness and care. It is, therefore, more important than ever to have an honest and open dialogue with people about their needs, and support them in a way that is helpful to them and their families.
We want people working in health and social care and people who use services to think about the values and the behaviours that underpin good experience. Drawing on these values to have meaningful conversations with people to plan and agree care will support all staff and patients to base care around what matters most to people, with a shared understanding of what healthcare might realistically contribute to this. This is the ethos of Realistic Medicine.
We aim to implement Realistic Medicine in a number of ways:
To achieve this, people using healthcare services and their families must feel empowered to discuss their treatment fully with healthcare professionals, in language and using information that is appropriate to help their understanding. This should include any possibility that a suggested treatment might come with side effects – or even negative outcomes. 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.
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, and championing innovation and improvement. These concepts are essential to a well-functioning and sustainable NHS for the future.
Realistic Medicine is about supporting people using healthcare services, and their families, to feel empowered to discuss their treatment. It is not about failing to offer treatments that are likely to have benefit. . That’s why changing our style to sharing decisions with our patients is one of our priorities. A move away from the “Doctor knows best” approach to shared decision making between the professional and patient will require more meaningful discussions about the treatment options available as well as their risks and benefits.
We must create the conditions that facilitate more meaningful conversations between people and their healthcare professionals; that help people make informed choices about their treatment and care options, based on what matters most to them. This involves trust, the provision of information in a way that allows understanding and time for reflection, so that people feel they have support in making these decisions, when this is their preference. We must recognise the differing levels of health literacy across our public, and whilst working to improve this, ensure that we communicate information appropriately for each individual, checking that this has been understood in the way it was intended.
Healthcare professionals are the stewards of healthcare resources. We know that both overuse and underuse of investigation and treatment can result in harm to patients. By seeking out and eliminating harm and waste, we can provide appropriate healthcare that is in tune with what people really value.
Variation in healthcare exists for all sorts of legitimate reasons, but identifying and tackling unwarranted variation is essential to improving outcomes derived from healthcare across Scotland. Unwarranted variation is variation in healthcare that cannot be explained by need, or by explicit patient or population preferences. We need to ensure the prevention of harm and waste from overuse and overtreatment, freeing up resources currently used without benefit to clinical outcomes in order to address under-provision of care elsewhere.
Realistic Medicine is not an endeavour for one profession alone, nor is it solely the remit of healthcare professions. The best, high quality care in the complex environment that we now live and work can only be fully achieved through working together in teams, in networks and in partnership with people; understanding and valuing the contribution that each of us can make for the individuals and to the communities of people that require health and social care.