Episode 20: Realistic Emergency Medicine
Author: Eoghan Colgan @eoghan_colgan
Special Guest: Catherine Calderwood @CathCalderwood1
29/08/18
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Guest Bios
catherine calderwood
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)
Links
Click on image to visit the ticketing site
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.
THE INTERNATIONAL SEPSIS SYMPOSIUM
Short, impactful talks from world experts in sepsis.
For tickets, click here
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.