The six principles of Realistic Medicine should be deployed to support the implementation of this prioritisation framework by creating a series of tools to aid clinical decision making and ensure care is delivered that adds greatest value to the patient and makes best use of the available resources. There will be difficult decisions and conversations to have with patients and ensuring a consistent application of these principles can support teams to deliver best value care. The following should be applied:
- shared decision making
- personalised approach to care
- approach to risk
- reducing harm and waste
- tackling unwarranted variation
- innovating and improving
All those waiting are required to be assessed to determine if they still require the test/ intervention, and whether their clinical priority has changed as a result of the length of time waiting. Realistic Medicine is a key enabler of the following:
- waiting list revalidation
- Patient initiated return PIR
- Active Clinical Referral Triage ACRT
- Effective Quality Intervention Pathways EQUIP
Realistic medicine principles specific examples:
Use of questions prompts
- This could form a generic information leaflet for all patients and be used as an initial screening tool to identify patients who may “opt out”. This should be adapted as procedure specific guidance by teams to reflect local service options/ changes. This approach could support ACRT.
Is this procedure or treatment necessary?
Some conditions are self-limiting, and may have improved naturally over time or with a more conservative management approach. E.g. Gastro oesophageal reflux can improve following a period of weight loss, hence no further need for treatment or investigation. Patient stories may be helpful to illustrate specific examples.
Does the patient understand the risks and benefits of the proposed procedure or treatment?
Patients with vulnerable immune systems or other comorbidities may require or chose an alternative approach to management to balance the risks of their condition against the risks of contracting Coronavirus.
Does the patient understand the alternatives?
Due to COVID-19 many new interventions have been accelerated e.g. Cytosponge in place of endoscopy for Barrretts oesophagus. Does the patient understand what would happen if they chose to do nothing?
Due to the wait for treatment many patients may have adapted or learned to self-manage their conditions better. We also need to be honest with patients about interventions of lesser benefit (EQuIP)
It’s OK to Ask/ NHS inform
Question prompts will be most effective if combined with a facility for patients to become more knowledgeable and informed. Signposting to information sources and on line FAQ’s could be a first line route for that information. Also if helplines could be set up for patients to ask generic questions that may free up clinical time for one to one discussion with those patients who most need them.
NHS NES has also produced an online introductory module to shared decision making and we would again encourage staff to complete it.
Ensure all professionals have read the GMC’s updated guidance on Decision Making and Consent.
The updated guidance focuses on person centred care and aligns with the Realistic Medicine agenda here in Scotland. It promotes shared decision making as the key to ensuring people receive the treatment and care that they need, based on what matters to them, and ensuring they have all the information they need to give informed consent.
Waiting Times Team: WTIP@gov.scot