Q&A S
COTLAND’S Chief Medical Officer Dr Catherine Calderwood has only been in post for a year but is already
causing something of a stir in the medical profession. Her first report, Realistic Medicine, has been widely praised, with enthusiastic discussions on social media site Twitter as well as at conferences and events across the country. Catherine, who qualified from
Cambridge and Glasgow universities, is an obstetrician and gynaecologist and continues to practise at a maternal medicine antenatal clinic at the Royal Infirmary of Edinburgh. She became a medical adviser to the Scottish Government in 2010 and has played a key role in reducing stillbirths and neonatal deaths in Scotland. She chairs a number of key committees, including the UK Maternal, Newborn and Infant Clinical Outcome Review Programme. She was the obstetrician on the panel of the Morecambe Bay Inquiry into maternity and neonatal services and is a member of the recently formed Review of Maternity and Neonatal Services in England.
In Realistic Medicine you said you wanted to start a conversation with doctors about changing healthcare. What has the response been so far? It seems to have been universally positively received. We’ve received hundreds of emails and online survey responses, and it is getting 60 to 100 mentions a week on Twitter. It’s been amazing. It seems to have really hit a chord with people, that they have thought it was speaking sense. It has been reassuring to find that there is such an appetite to change the way we practise medicine, with the two most common themes being shared decision making and personalised care.
Your report raises the issue of overtreatment and notes that doctors “generally choose less treatment for themselves than they provide for patients”. Why is that? Tere’s a lot of research, mostly involving doctors at the end of life who have a terminal diagnosis. Figures show, for example, that 88 per cent of doctors wouldn’t have haemodialysis, 95 per cent wouldn’t have CPR, and 67 per cent wouldn’t agree to be admitted to intensive care. Having discussed this with doctors with expertise in this area, I think it is because we have seen the downsides of
10
Being realistic
for patients
Dr Catherine Calderwood talks to Summons about her ambitious plans for a common sense, patient-focused approach to healthcare
some of these treatments and know the reality of being hospitalised or admitted to intensive care. Tere’s also evidence that doctors don’t fully understand what patients want. Research has shown that doctors assume patients will prioritise living longer over anything else but, when asked, patients say they want two things: to be symptom-free and to spend time with their families.
What are the factors involved in overtreatment and how do you think we can reduce it? Doctors are fixers by definition, that’s the
nature of the job. It is also an individualised issue because some patients will want everything done no matter what the discussion is. Part of the reason for writing Realistic Medicine came from hearing clinicians tell me they wouldn’t undertake their own treatment. A respiratory physician specialising in lung cancer told me that, given that diagnosis, he wouldn’t have chemotherapy because he has seen the side-effects. Perhaps we should be more open and transparent with patients about the real impact of some of these treatments? Tat is one of the questions I am asking in my report.
SUMMONS
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