Practising Realistic Medicine: Chief Medical Officer for Scotland annual report

The Chief Medical Officer's third annual report on applying the personalised, patient-centred realistic medicine approach across Scotland.

Introduction from the Chief Medical Officer


When I wrote to doctors across Scotland in 2016 describing the principles of Realistic Medicine I was not confident that they would read my first annual report let alone agree with the sentiments expressed. Two years later, however, Realistic Medicine has become embedded far beyond the medical profession and in numerous contexts in Scotland, a “social movement” to some extent but also being deliberately written into NHSScotland health and social care policies, guidance documents, teaching and learning packages, information for patients, medical school curricula and the selection process for medical students. It has been welcomed by very many healthcare professionals from multiple disciplines and this extends now across the world with many tens of millions of impressions on Twitter and influence on healthcare policies worldwide. There has been enthusiasm from our partners in the third sector, the General Medical Council ( GMC) and British Medical Association ( BMA), the Royal Colleges, and of course very importantly the public in Scotland, as you will see in this report – Practising Realistic Medicine.

There have been challenges put to me – the most common being lack of time. Lack of time to really discuss people’s priorities, lack of time to ensure they have all the information needed to make a fully informed, shared decision, while aligning with many and varied expectations. I also feel the pressure of time in my antenatal clinic and I recognise these issues and share some of the other frustrations with the “system” which are described to me. Some of those challenges have been countered by fellow professionals – “don’t make a major decision in one appointment”, “offer people the chance to discuss at home and come back”, but this is not always possible or desirable, particularly in the emergency situation. There is recognition too that some of our colleagues are very good at this difficult communication, even when under pressure of time. There is a need to learn from those who do this well but also to teach communication and recognise levels of health literacy rather than make assumptions about inherent skill or knowledge. This report builds on the principles I have discussed in Realistic Medicine and Realising Realistic Medicine.

I keep coming back to the tremendous privilege it is to be a doctor. Many have commented to me that Realistic Medicine brings them back to the reasons they wanted to work in health or social care in the first place. A third year medical student spoke to me after one of the first Realistic Medicine talks I gave. “I don’t want to be rude” she said, “but I don’t really see why we need this report – isn’t this what everyone should be doing anyway?!”

While we rightly set high value on the care we provide for others, at times the “doctor as human too” may be left out of the equation. Sometimes attitudes within and between professions fail to recognise how essential all members of the team are across multiple disciplines and from the most junior to those with most experience. We are our own worst enemies at times. A new chapter in this report examines how important it is to value our staff and we know that this will have a positive effect on the outcomes of our patients. I hope that this latest report will help to translate the principles we have already described into practice in real life, working in whatever part of the system you are delivering care. The most important part of our jobs is to provide the best care possible, but in order for that care to be optimal it is essential that we look after both ourselves and each other.

The intention of this report is to support and accelerate the transition from a discussion about the principles of Realistic Medicine to their practical application in the complex world of health and social care. In the future, I anticipate that the way we communicate with you will change further, using a variety of different media and more frequent and practical releases on particular aspects of Realistic Medicine, including tools and case studies, to assist you in Practising Realistic Medicine. I hope you enjoy this report and, as ever, welcome feedback.


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