Realistic Medicine Flashcards
What is the idea of realistic medicine?
This is the idea where providing relief from disability, illness and death, medicine may have overreached itself and now cause hidden harm:
- Should focus on what the patient values
- Evidence-based guidance may not necessarily be appropriate for patients with multiple conditions due to possibility of over treatment
What are the 6 principles that realistic medicine (2015) describes?
- Build a personalised approach to care
- Change our style to shared decision making
- Reduces unnecessary variation in practice and outcomes
- Reduce harm and waste
- Manage risk better
- Become improvers and innovators
To practice realistic medicine, what 5 questions should you ask yourself before giving treatment?
- Is the test, treatment or procedure needed
- What are potential benefits and risks
- What are possible side effects
- I there a simpler, safer alternative
- What would happen if I do nothing
What is personalised care?
This is patient centred care (refer to lecture)
Illustrate risk to patient, and consider if risks of treatment are worth it for what is going on:
- Consider actual risk and relative risk
What makes a good consultation with a doctor?
- Feeling listened to and not rushed
- Clear communication
- Resolution (diagnosis/outcome)
What makes a good doctor?
- Knowledge
- Listening
- Friendly
What allows for shared decision making?
Good consultation with doctor:
- Feeling listened to and not rushed
- Clear communication
- Resolution (diagnosis/outcome)
What makes a good doctor:
- Knowledge
- Listening
- Friendly
The above allows decisions to be made together
What is used to reduce unnecessary variations in practice?
Guidelines are based on evidence:
- To provide the most benefit for the least risk
Not always appropriate for patients with co-morbidity
What are examples of common conditions that are over-diagnosed?
- Asthma
- Prostate and thyroid cancers
- CKD
- Attention deficit hyperactivity disorder
What are the consequences of over-diagonsing conditions?
This causes medical, social and economic consequences
A lot of the population has “issues” that are asymptomatic, and only detected if you go looking causing overtreatment and problems with unnecessary side effects
How is risk better managed?
Hypothetico-deductive reasoning is used to establish a diagnosis without needing to investigate all of the possibilities:
- Safety netting also used
Risk various from patient to patient depending on their unique situation
How do doctors become “improvers and innovators”?
- Using data to support discussions and learning in clinical teams
- Reflection
- Consider how to improve for next time
