Episode 20: Realistic Emergency Medicine

Author: Eoghan Colgan    @eoghan_colgan
Special Guest: Catherine Calderwood   @CathCalderwood1




Guest Bios

catherine calderwood

Catherine Calderwood.png

Catherine Calderwood MA Cantab. MBChB FRCOG FRCP Edin Hon FRCP Glasg Honorary Colonel 205 (Scottish) Field Hospital.  

Catherine Calderwood has been the Chief Medical Officer for Scotland since 2015.  

Catherine qualified from Cambridge and Glasgow Universities and continues to work as an obstetrician at a regular antenatal clinic at the Royal Infirmary of Edinburgh.  As a junior doctor she worked in medical specialities in Glasgow Royal Infirmary and at the Royal Infirmary of Edinburgh before completing her specialist training in obstetrics and gynaecology and maternal medicine in SE Scotland and St Thomas’ Hospital London. 

As a medical adviser to the Scottish Government she was instrumental in the work which has led to a 20% reduction in the number of stillbirths across Scotland. She continues to support this work and the work in reducing neonatal deaths and avoidable harm in maternity services.  She has overseen the development of a Major Trauma Network for Scotland.  She is Chair of the Taskforce for the Improvement of Services for Victims of Rape and Sexual Assault, the Committee on Antimicrobial Resistance in Scotland and the Scottish Global Health Collaborative and is a member of the Advisory Council on Women and Girls.  She has published physical activity guidelines for babies and children, pregnant women and adults and low risk drinking guidelines along with the Chief Medical Officers in England, Wales and Northern Ireland.

She is responsible for the Health Promoting Health Service initiative which aims to tackle health inequalities and improve health across the population of Scotland and is leading work to improve the health of those working in the public sector specifically NHS and civil service staff

Catherine has published three annual reports onRealistic Medicine.  Realistic Medicine puts the person receiving health and care at the centre of decision-making and creates a personalised approach to their care.  Her second report published in February 2017 builds on the first report by setting out a vision and priorities: showcasing international and national multi-professional support from clinicians, leaders from medicine and public health and stakeholders from a wide group of organisations.  Her third report published on 20 April 2018 will help embed Realistic Medicine and allow the spread of good practice which has been seen throughout Scotland. These reports have been universally well received and read by millions of people across the world. The reports also recognize the importance of valuing and supporting staff as vital to improving outcomes for the people in their care. 

Show Notes

Eoghan discusses Realistic Medicine with the author of the manifesto, Dr Catherine Calderwood. They discuss the origins of the paper, the main take-home points and how we can all practice a more thoughtful and realistic type of medicine.

Take Home Points

Chief Medical Officer of Scotland

  • The senior medical advisor to the Scottish government (advised about the health of the Scottish people)
  • Works independently of Government


Realistic Medicine

  • Was borne from discussion with doctors and the feeling that they get unable to practice the type of medicine they wanted to
    • in the best interests of the patient
    • not putting patients at the heart of decisions
    • intervening too much
  • REALISTIC = a true and accurate reflection of what could happen


1. Building a Peronalised Approach to Care

  • finding out about each individual patient
    • understanding their background
    • what do they want from their treatment?

2. Shared Decision-Making

  • we often do things to patients that we would not want done to ourselves
    • doctors often overestimate the benefits and underplay the negative effects of treatments
    • ensuring we give patients the facts and let them share in the decision-making process
  • ask yourself do you know what your families wishes would be if they became ill??
  • communication
    • needs to be part of formal training (and examined)
    • it is vital to what we do and as important as the technical skills

3. Understanding and Managing Risk

  • when under pressure, decision-making becomes more risk averse
    • like more conservative decisions
    • tend to over-intervene
    • not often optimal care
  • senior staff can absorb some of those more difficult decisions and know how to support their staff to take sensible risk
  • look after each other
    • understand the stress points in your department
    • the best atmosphere is when staff know each other personally

4. Reducing Harm and Waste

  • be considerate in your job and identify where waste could be reduced

5. Reducing Unwarranted and Unnecessary Variation in Practice

  • there is considerable variation in lengths of stay, readmissions, procedures and complications between units and hospitals
  • an Atlas of Variation will be published soon in Scotland highlighting this variation
    • this will inspire local change
    • teaching around vale-based healthcare will be included
      • ensure value for money and value for the patient is achieved
      • don't do things that don't add value to the patient

6. Become Improvers and Innovators

  • 'improvements' are often made by people not actually doing the work
  • encourage staff to find innovative solutions to problems we face in healthcare


Priorities for Emergency Medicine in the Coming Years

  • acknowledgement of the nature, intensity and pressure of work we face
  • changing attitude to our impact on flow through the hospital
    • we are not the 'gatekeepers'
    • ED often gets the blame for waiting times
      • we do not control the volume that arrives or the roadblocks that prevent flow through the hospital
      • flow much more affected by issues downstream
  • we need to take good care of each other given the pressure we are under


Piece of Advice to Junior Self

  • seize every opportunity you are granted
    • both within, and outside, the NHS
  • don't think the only job you can do is the one you started with
  • find out about the people you help and take an interest in them (if appropriate/possible to do)





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The Realistic Medicine Conference is now sold-out but they are looking to extend capacity. They are also looking for poster presentations. If you have a poster or would like to be added to the reserve list for the conference then please email Helen.Mackie@scotland.gsi.gov.uk

If you have a ticket and are no longer able to attend then please release the ticket so someone on the reserve list can take your place.



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Dr Calderwood made a call for people to send video clips talking about their experiences of shared decision-making (it was tweeted it here: https://twitter.com/RealisticMed/status/1020322906042138625. The CMO will use those clips to create a social media campaign, which will encourage people to feel comfortable talking to their healthcare workers about their care and treatment options. It would be great to hear from as wide a range of people as possible, and we want to hear all kinds of different stories – both the good and the bad.

Hannah BellComment