Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016

Report on the adoption of the personalised, patient-centred Realistic Medicine approach in Scotland's health services.

Executive Summary

Realistic Medicine puts the person receiving health and care at the centre of decision-making and creates a personalised approach to their care. It aims to reduce harm, waste and unwarranted variation, all while managing risks and innovating to improve. These concepts will be essential to a well-functioning and sustainable NHS for the future.

Realistic (definition)


1. Having or showing a sensible and practical idea of what can be achieved or expected.

2. Representing things in a way that is accurate and true to life.

This report has been prepared in response to the feedback around Realistic Medicine and sets out a future vision and strategy to realise Realistic Medicine in pragmatic terms.

Realistic Medicine in the International Context

When 'Realistic Medicine' was published it became clear that there was interest in its content from outside Scotland. On Twitter #RealisticMedicine reached nearly ten million feeds on almost every continent. This virtual network is enhanced by real time collaboration. Contributions from international figures can bring experience and expertise that will support the realisation of Realistic Medicine. There is a broad international movement with consensus around the need to co-create health with people and tackle unsustainable and undesirable practices in healthcare.

Realistic Medicine, People we care for and support and the Wider Public

Over the course of 2017, with support from the Scottish Health Council and the ALLIANCE, we look forward to establishing what Realistic Medicine means to people we care for and support and the wider public. We must gain a true understanding of what the concepts described in Realistic Medicine mean for those accessing health and care services, in order that we can truly co-produce a realistic approach to health and social care. A number of methods will be used to find out how best to achieve this, including focus groups, the Citizen's Jury and Citizen's panel.

Realistic Medicine as a Multi-professional Endeavour

Realistic Medicine has resonated with many professions providing health and social care. Here, the term 'medicine' does not solely apply to the work carried out by doctors - it should be considered as the broad concept of using skills and knowledge to maintain health and to prevent, identify and treat illness. It is impossible to achieve Realistic Medicine without a truly multidisciplinary approach, appreciating the varied skills and experience of the health and social care workforce in Scotland. It is more important now than ever to gain a shared understanding of what Realistic Medicine means in different health and social care contexts. I have invited my fellow Chief Professional Officers in Health and Social Care to discuss what Realistic Medicine means in their professions and to establish how we can work together to achieve the aims of Realistic Medicine.

"Realistic Medicine can be seen more as a thread that runs through all work to improve and change care and is constantly referenced, rather than a stand-alone concept."

Creating the Conditions for Realistic Medicine

I asked for feedback on my first report and this confirmed that colleagues across Scotland identified with and supported the themes within Realistic Medicine. I received stories from people about what practising Realistic Medicine had meant to them and how this resonated with changes that they had made, or were making, in their own practice. People felt most energised by the potential to positively influence culture through more shared decision-making, and to reduce harm, waste and variation. Delivery of these linked aims, fulfilling our collective desire to change the focus of care, will require a co-ordinated set of actions across all clinical and care professions in Scotland, but as practitioners and leaders in our own systems, each of us has the ability and the licence to make progress with this. Simultaneously, a number of national initiatives will support this by helping create the conditions for Realistic Medicine to flourish at this local level.

Realistic Medicine around Scotland

My team have spent time over the past year meeting and speaking with professionals to find out about examples of Realistic Medicine going on all around Scotland. My report highlights some case studies of work that reflects the principles of Realistic Medicine, and further case studies can be found at this link:

I look forward to continuing to work with you to champion Realistic Medicine so we can deliver a modern and innovative health and care system for all the people of Scotland.


Email: Catherine Calderwood

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