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Scotland’s CMO calls for more ‘realistic medicine’

Move away from ‘doctor knows best’ to avoid overtreatment and cut waste

Louise Prime

Wednesday, 20 January 2016

Scotland’s chief medical officer has this morning called for a move away from a ‘doctor knows best’ culture towards more ‘realistic medicine’. Launching her first annual report as CMO, Dr Catherine Calderwood said that she wants more debate involving doctors themselves about how they see the future of the health service – and for the medical profession to encourage more discussion with patients about what matters to them as individuals.

The CMO said that as the number of available treatments and medicines is increasing, along with a rise in public pressure and expectations, and ever-increasing numbers of patients living with multiple morbidities, there can be a tendency towards overtreatment – which, she pointed out, may be wasteful and of little long-term benefit to the patient. She called for greater transparency in decision making, and she argued that, when fully consulted and informed, many individuals may decide that no treatment is the best option or them.

The CMO said doctors nationwide are doing a ‘tremendous job’ in adapting to changing demands facing the NHS. She said: “The challenge to us as doctors is to ask ourselves how we can change our own working practices to create even better outcomes for patients.

“In striving to provide relief from discomfort, illness and death, modern medicine can sometimes over-reach itself and provide treatment that is of little long-term benefit to the patient. This is especially true when a person has multiple conditions, each of which has its own list of recommended medicines and treatments.

“Realistic medicine is about moving away from the ‘doctor knows best’ culture. It’s about more fully involving patients in the decisions about their care. Of course this will only happen if people are prepared to have these conversations in this way with their doctors.”

She pointed out that when doctors themselves need treatment, they often opt for fewer treatments than they offer their patients. She said: “As doctors we should be asking why that is, and whether patients – if better informed – might also choose less intensive and less medicated treatment regimes. A person may achieve a greater quality of their life if less is done – fewer treatments, more targeted medication.”

Dr Calderwood, an obstetrician and gynaecologist, also called on doctors to question variation in practice and outcomes; to reduce waste; and to encourage innovative ideas and research to improve medicine for the future.

Chair of BMA Scottish Council Dr Peter Bennie responded that burned-out doctors no longer have the appropriate time in their busy working lives to learn, teach and reflect, even though they want and expect to innovate and lead in improving patient outcomes. He said: “Whilst doctors can play a vital part in supporting the development of new approaches to healthcare models we must recognise that morale amongst Scotland’s doctors is very low with workload intensity continuing to rise, and that this is likely to have an effect on how well doctors can respond to the needs of a changing health care service and growing patient demand.”

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