Realistic medicine to me is the embodiment of modern day, pragmatic common sense healthcare. How hard can that be? So ladies and gentleman I present to you a day in the life of Realistic Medicine….
It was the day after the incredibly thought provoking #RealMed2017 conference. Now I can’t say I went to work brimming with new ideas as intuitively I try to practice this everyday. However I know that many find the concepts a direct challenge to their current practice. With that in mind I thought I’d begin by looking for opportunities that would highlight Realistic Medicine in practice.
The educationalist in me also wanted to tie it into ‘educational moments’ in the hope of expanding the current thinking of whoever I came across.
Great, let’s do this….
No wait up, I have a pile of results to go through and Immediate Discharge Letters (IDL) to check before I go to the ward. That won’t take long and then I’m all about the realistic medicine.
What’s this? – ‘will need a follow up CT thorax in 3 months’ Ok, has it been ordered? Also why is it needed? It’s not mentioned on the IDL. I know it’ll be documented in the case notes. Ok, got it. Back to the IDL. Surely the FY1 has not thought that their GP should be organising this?!? *sigh* I’d better dictate a letter to the GP to apologise and say we’ll be doing that. Oh and email my secretary to get the letter done and away today before I get an angry phone call from my primary care colleague. Whoops, nearly forgot to mention that I’ll see them in clinic.
Ok, that only took 10 minutes. That’s annoying but it’s done. No, wait I still haven’t clarified if the CT has actually been ordered….
Are you kidding me? The IT system had locked me out for putting in the wrong password – again. It’s been glitching all week by not remembering passwords.
Not to worry, I have a very reliable Nurse Practitioner who assures me it was ordered and is able to show me it on the system. Sorted.
Which reminds me I need to follow up on a previous discussion with my junior staff about what counts as reasonable requests to pass on to Primary Care. I find asking them to do reflective accounts quite helpful. One of my colleagues jokingly asks if I use them as a form of punishment. No! (but it is more constructive that getting them to write ‘I must not do it again’ a hundred times).
Part of the discussion also centres on the role the patient plays in all of this. Do we assume that patients play a passive role when it comes to their health? I think we do. It is as much about explaining to them what needs done and why in order that they take ownership too. ‘I would suggest when you get home you ring the practice to make the appointment to get your bloods done’
On that topic of shared decision making the thrombolysis phone rings as I’m mid talking to a family. The person has just been diagnosed with cancer and we’re waiting to hear back from the specialist team about the next steps. It is heartbreaking to see them so upset. They just want answers. I want to spend longer but I’m being called to the Emergency Department. I don’t have time to just sit and listen. I feel guilty at having to leave mid conversation. They understand but for a moment I let one thought creep in ‘I hate that stupid phone for making leave’
Then I check myself. Someone else needs help and quickly. I abruptly switch my focus. It’s no ones fault but never the less it doesn’t feel right.
Off we go, I take my CMT (core medical trainee) with me to see what happens. Things go on fast forward as it’s a time dependent treatment. We get to the decision making – I don’t think we should proceed for a variety of reasons. It’s a fairly comprehensive list of pros and cons conveyed using simple, straight forward language. ‘Anything you’re not sure about? What do you think?’
The reply: ‘You’re the doctor, you know best. You decide’
Right. Well, it’s a decision. Was it shared? I think so. I’ll ask them about it again later.
This isn’t an unusual day with unique situations but normal, everyday life in medicine. Did anyone think about them within a Realistic Medicine context? Not really.
One of the comments at the conference was around ‘affecting wider cultural change and not just having these conversations in the vacuum of healthcare’. I personally get frustrated at the language we use and the surprise to which people react with when change isn’t happening.
Adapt your language to meet the needs of who you are talking to. Do not patronise however. Patients, relatives and healthcare workers are smart people. They want and deserve to be listened to as well as being treated fairly and honestly.
Realistic Medicine to me is about what would you want for you and your family/friends? It is awonderfully simple concept but to deliver it within the complexity of healthcare, well, you just need to keep it real….
For more info on Realistic Medicine can be found here: