think of them as the person they are the rest of the time. I think there’s a shift, we’re starting to shift conversations.” What does realistic medicine look like for Kirsty’s mum? Calderwood


says it is about balancing service needs with the needs of vulnerable people. Health literacy is also a factor, she says. “Forty-three per cent of working-age adults can’t work out the dose of paracetamol for a child from the side of a bottle. We talk to people, I think, without necessarily recognising what level their understand- ing is.”


And for somebody in their first pregnancy, like Caley, it is about


remembering how unfamiliar the experience is. “I know myself when I was in labour for the first time, everybody


said, ‘why were you scared? Why was it scary? You’ve seen it every day.’ Yeah, but it’s never happened to me before. “I was much less scared, actually, because at least the people were familiar faces, the people I worked with, but imagine feeling like that in a completely alien environment. I knew where the stairs were, I knew who was coming to see me, I said ‘hi’, I knew what the rooms looked like, and I was still scared. Tat’s a familiarity, not putting yourself in the shoes of Kirsty’s mum.” But at a time when many professions in both health and social care


are expressing concerns about workload and the length of time they get for appointments, is it possible? Calderwood acknowledges these have been brought up in the ‘realistic medicine’ conversations. “Kirsty’s mum’s midwife will have far more work than midwives used to have, because we’ve added in screening, smoking cessation, all of these things, and the midwife’s role has changed.” Tis, she offers, is why the Scottish Government is investing in more midwives and health visitors. Te other aspect to come up in approaches to realistic medicine is mental health. If Caley had anxiety during pregnancy or post-natal


depression, it would have a direct impact on Kirsty’s chances of suf- fering from mental illness. With twelve per cent of pregnant women experiencing postnatal depression, it is the most common complica- tion in pregnancy. “And we’re not good, we talk about having a clot in your leg, pre- eclampsia, we talk about diabetes, but postnatal depression is more common than all of those. It’s disproportionate,” says Calderwood. Mental health feeds directly into understanding the person rather


than the patient, according to the CMO. She describes a survey which revealed “the same disconnect”, a gap between what medical profession- als thought people wanted and the reality, particularly at the end of life. “Te doctor was saying, ‘yes, we’re giving them all this treatment so they can live longer’ and then they asked the actual people they were treating and they said two things: they wanted to be symptom free, and wanted to spend time with their family. None of them mentioned living longer,” Calderwood remembers. She says health and social integration is currently focused on “delayed discharge, and at the end of people’s lives”, and should be starting to look at how it can help people like Caley by linking maternity, social services and mental health support. As preventative spend, maternity services can stop many problems in the health service in the future, she suggests. “Investing in the mothers means investing in the children and the teenagers. “It keeps going back and back and back. I’m always talking about the midwives and the obstetricians and preconception – that’s the future health of the nation. Nobody recognises that. It’s the downstream preventative investment.” And as for the maternity review, Calderwood hopes it will not just change outcomes for mothers and babies, but listen to them too. ⌜


23 May 2016 www.holyrood.com 35


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