CMO places personalised care at centre of medicine

Latest report emphasises necessity of collaboration between the public and practitioners to deliver realistic medicine

Thursday 25th April 2019

The most senior doctor in Scotland is encouraging healthcare professionals to build a more personalised approach to patient care as part of the realistic medicine agenda – a new way of thinking about healthcare that firmly rejects the tradition of ‘the doctor knows best’.

In her latest annual report, Catherine Calderwood, the Chief Medical Officer (CMO), details how doctors and nurses can flip the question ‘what’s the matter with you’ to ‘what matters to you’ – and the benefits it can bring.

Meanwhile, 61% of almost 2,500 NHS staff surveyed for the report believe realistic medicine has had a positive influence – but just over a third said insufficient staff time was a barrier to developing the agenda further.

Delivering personalised care was the most popular principle among health service staff.

Launching the report today at the Royal College of Physicians of Edinburgh, Dr Calderwood said:

“Everyone who works in health and social care wants to deliver the best possible care and treatment for the people they serve.

“However, simply recommending more tests, treatments and procedures does not always provide the best outcome for people, even if that care is delivered at the very highest level. We must be sure that we deliver the right care to the right people at the right time in the right place.”

In her fourth annual report, the CMO provides examples from across Scotland – and the wider health and social care sector – of professionals and patients working together to tailor their care to the individual.

In mental healthcare, young people on the cusp of moving to adult services are asked about their ‘needs, wants, preferences and concerns’ ahead of the shift. Doctors in NHS Lothian now assign support workers to people who frequently attend A&E in acute crisis and work with carers, relatives and the hospital team to draw up a care plan focused on the patient that also helps staff.  

The report touches on simpler – but no less effective – ways patients can be meaningfully involved in their care. ‘Each week, thousands of letters are sent about patients in Scotland but rarely are they shared with the person concerned,’ Dr Calderwood states.

Dr Steinunn Boyce, an NHS Fife realistic medicine clinical lead and consultant in palliative medicine, offers to write directly to patients summarising the often-difficult conversations about terminal illness that take place in her clinic – to date, the report states, no patient has declined this.

Elsewhere, doctors are writing directly to patients and their GPs, using non-technical language to explain their treatment plans, next steps and how they can access their test results themselves.  

 “We must accept that, to deliver Realistic Medicine, we need to consider many factors besides medicine,” says the CMO, who believes the challenges to realistic medicine can be overcome by listening to the public’s views.

In February, healthandcare.scot reported on citizen’s juries that looked at different options for how patients could be more involved in decision-making – and coming up with a set of recommendations for how this can be achieved.

These are cited as an example of ‘compassionate, pragmatic and reasoned participation’. Elsewhere, GPs are urged to let patients speak more during appointments, giving the doctor vital information that can be used to personalise the treatment decided on.

Dr Calderwood added:

“We also must not lose sight of the fact that our workforce are our most valuable asset and we need to look after them too. We need to continue to provide compassionate leadership and create environments where our staff feel valued, respected and supported.

“Having witnessed the fantastic progress that’s been made over the last three years, I am convinced that now, more than ever, we can build a personalised approach to care together.”