• Realistic Medicine; What?Why?How?

  • 著者: Dr Kate Arrow
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Realistic Medicine; What?Why?How?

著者: Dr Kate Arrow
  • サマリー

  • In this series we will share the evidence behind Realistic Medicine, Scotland's approach to a sustainable health and social care system, as well as the stories, experiences and projects of teams and communities across Scotland. We want to share best practice, create an open source resource of experience and ideas to empower everyone to practice Realistic Medicine. If you would like to share your story or get involved, please email us on nhsh.realisticmedicinehighland@nhs.scot
    © 2024 Dr Kate Arrow
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あらすじ・解説

In this series we will share the evidence behind Realistic Medicine, Scotland's approach to a sustainable health and social care system, as well as the stories, experiences and projects of teams and communities across Scotland. We want to share best practice, create an open source resource of experience and ideas to empower everyone to practice Realistic Medicine. If you would like to share your story or get involved, please email us on nhsh.realisticmedicinehighland@nhs.scot
© 2024 Dr Kate Arrow
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  • Complex decisions, shared; Dr Suzie Farrell & the Shared Decision Making clinic.
    2022/11/09
    Kate: Welcome to episode four of our Realistic Medicine podcast. I'm Kate Arrow. I'm an Anaesthetist in NHS Highland and today we've got Doctors Suzanne Farrell, who's an Anaesthetist and Intensive Care Consultant in NHS Lanarkshire. And Suzanne is going to share a little bit about her experience with Realistic Medicine. And we're going to have a bit of a focus on some work she's been doing setting up a shared decision making clinic. So, Suzanne, do you want to tell us a little bit about yourself?Suzie: Hi, Kate. Thanks for having me. It's an absolute pleasure. Yes. I suppose the first thing I should say is, call me Suzie. Okay. I'm an Anaesthetist in Lanarkshire and also in Intensive Care, and I've been a consultant there for just over ten years. So I guess what's brought me to Realistic Medicine has been a kind of circuitous journey. But if we start off by saying that half of my working week is in high risk anesthetics and the other half is in intensive care, that gives me a kind of dichotomy in my job because I love talking, I'm a gab, I like patients, I love hearing their stories. And as you know, you do the same job. It's really difficult when half the time you're spending your work and caring for patients that are unconscious. So I have this desire to not just deliver high quality anaesthesia, but also to really engage with patients and as much as I can, I guess I started off doing a Monday vascular list. That was difficult because it meant I had to go and see my patients on a Sunday. I thought, that's not good. Like, you know, I don't want to go on Sunday and meet my patients at the last minute. But the kind of process evolved and I started bringing patients up the week before. Then I started involving the surgeon and said to the surgeon, listen, why don't we go and see the patient together? This is high risk stuff. Then I developed an interest in assessing high risk and what high risk actually means. I got funding. I managed to put in a business case and successfully got funding for cardiopulmonary exercise testing, which is one way of stratifying risk. So it kind of grew from there. And I think what I was trying to do was do the consent process better. But despite that, I just still had this sense that it wasn't enough. Although we were telling people what the risks were, it was almost when the decision was made for them. And I kind of got this. There was a few notable cases there's, a few patients that really stick in my mind over the years, but despite the risk assessment, having said, yeah, you know what? Probably good to go ahead, did badly or didn't do as well as I hoped they would. So I had this kind of growing idea that there might be a different way to do this. So literally, about seven years in, no part of a lie, I got this, itch. I had to go somewhere. Now my best friend says I've got itchy feet and my husband says that I've always got a project on the go. So despite having four children, I decided that the next project was going to be I was going to try and find another way of thinking and another way of looking at this particular group of patients who are very, very high risk for surgery. So I came across a job in New Zealand and I applied and I spoke to them and I said, listen, I want to come and work for you, because they were looking for a locum, really. But what I wanted to do was join a clinic that they had already established there and they had this clinic model that they called 'Complex Decision Path'. So I started trying to line up all the docs and negotiate with my workplace to go away for not just the three months sabbatical that you earn after seven years as a consultant, but really to go that far, I wanted to be away for a year. So I had a lot of persuading to do. And NHS Lanarkshire supported me, ultimately, and going away turned out to be on the brink of a pandemic. So in January 2020, I dragged my husband and four children to the other side of the world just for a breath of fresh air and to try and see if there was a different way to do what I was doing. And oh, my goodness, what a great decision. So I participated in the clinic there, which was really different, really labor intensive. Instead of it just being a patient coming to see Anaesthetist face the fase, to discuss risks, they have two consultants. And I think that that's an expensive idea for the NHS. But actually I think it is so valuable, you'll know yourself, Kate, that Anaesthetists, like surgeons, have got different attitudes to risk. And I think the problem with a lot of high risk patients coming to see one anesthetist is that although one anesthetist might have a risk discussion with a patient and think, yes, okay to go ahead, we've discussed it all, we've been through the consent process. The patient comes on the day for someone different. So definitely there's two things I'm really not sure about this. So that creates a problem. Patients then can get cancelled on the day. They're deeply disappointed...
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    28 分
  • Norma's story; 'This is my reality.'
    2022/11/02
    Kate: So we're on episode four now of this podcast, which is called Realistic Medicine. What? Why? How? And we're really be lucky today to have Norma Davidson with us, who is a resident here in the Highlands and has been a patient and a member of the community and is a really prominent member of the Highland Senior Citizens Network. And so Norma is going to kindly share some of her story with us today, which will be really helpful. So, welcome, Norma. Thanks so much for joining us. Tell me a little bit about yourself.Norma: Well, first of all, you've already introduced what my name is, so the first is I grew up in the Highlands of Scotland, all over, but I ran away from home when I was 14 and pretended I was 16 and joined the QARANC, Queen Alexandra's Royal Army Nursing Corps in England. And from there I took ill when I was in the army and they had to do the very first operation on me that I'd ever had in my life, where they found I suffered from anaphylactic reactions to many anesthetic drugs. So under British law, you couldn't be in an armed forces with that because you'd be a danger. So I threw a dart into an atlas and it landed in a country called Rhodesia. So I packed up everything and just went to Africa. When I got there, I joined their military, which was combined forces, but carried on with nursing training and we would work with casualties, evacuating people out. I learned to fly an airplane and land it in case the pilots got shot, because this was a wartorn country. And this carried on to about the late 1970s. And then in 1979, I hit a landmine where everything changed because it was then found I became an incomplete quadriplegic. After everything settled down, I can move sometimes. I've got no sensation in a lot of parts of me. Every time I take an anaphylactic reaction, it causes swelling in the body and when that swells up, it also seems to cause problems in my spine as well. And it can take me ages to start getting movement back after each episode has gone, been cleared and I'm out of ICU. Can take months. I eventually got transferred back to Britain in 1986 and that was when local NHS and things got involved, because, yes, I was an incomplete quadriplegic and it's a CTC five. But I shouldn't be defined. That doesn't define me, who I am, it's what I can achieve. But then I was taking anaphylactic reactions to everything around me. I was in one hospital for 90 times in one year with anaphylactic reactions. So it was decided they were going to try and work out what was causing this. And they realized that I had what was called hereditary idiopathic and acquired angioedema, which all turned into anaphylactic reactions. The physical side of me, the disability, I can cope with. But that's the side that takes over everything, because you go to hospital, you'll take a reaction when you go through the door. Doesn't matter what you were going in for, they deal with the reaction get you out, realize, oh, we haven't done tests, we haven't done anything. I had a fantastic doctor later on who then took over and said, we've got to work a plan because I was falling through cracks. And we then started with a different way of keeping me all together. And that's just roughly, in a nutshell, probably 40 years all come together.Kate: Wow. What a fascinating journey you've had. And then what do you enjoy doing in life now back in the Highlands?Norma: Anything that, as you can see, I like activities, I like action. Doesn't matter what it is. I like to be a dare devil. I've always been a dare devil. So even now, even in my wheelchair and everything else, as people in the Highland Senior Citizens Network know, one of their staff is traumatized. When a few years ago, with NHS, we had people from NHS and the government, but I decided I wanted to go to the skate park in my wheelchair and they did a film for NHS and I did it. And I finally got to the very top of the park, which nobody's ever done in the wheelchair, but they forgot to pull the camera through back, to stop me hitting the camera through. I pushed my wheelchair around to fly off the top and crash landed on the floor. And I was just so excited going yes, yes. But everybody was running, thinking, she's broke her neck proper this time. So, yes, I still like to, even if it's the tiniest thing in the house. And I can't move that day as long as I've done something that I can do, I've done something.Kate: Yeah. That's amazing. You're braver than me, that's for sure. You don't catch me in skate park.Norma: I don't do that now. But that was about four years ago, was the last time we were out.Kate: So tell me a wee bit about what's most important to you, particularly from the delivery of your health and your care. What's important for you?Norma: Well, the main part, I think the whole lot would come under one heading of this is my reality and keeping it real in my care. To me, it's got to feel you've got sufficient time with the carers or the doctor, ...
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    28 分
  • The Programme Manager's perspective
    2022/10/27
    Lyndsay: Hi, everyone. I just like to welcome you to our latest Realistic Medicine podcast. My name is Lyndsay Stewart and I am the programme manager for Realistic Medicine in NHS Highland. So in this episode today, I'm joined by Amanda, who is one of our programme managers in NHS Grampian. And what we're wanting to do today is just have general discussion about what we do, what made us want to be involved with Realistic Medicine and what sort of challenges and successes that we've had. And then our must do recommendations for anybody new who's starting with Realistic Medicine or looking to implement it in services in their health boards. So, like I said, my name is Lyndsay Stewart and I'm based in NHS Highland. So my background is non clinical, so I do a lot of work still currently within endoscopy service within Raigmore for NHS Highland. And as a programme manager for Realistic Medicine, really our role has been a central point of contact, so anybody can come to us for advice or any questions that they have, try to get communication out for Realistic Medicine and to manage and co-ordinate activity. So that's a little bit about myself and I will hand over to Amanda to introduce yourself.Amanda: Thanks, Lyndsay. So, yeah, as Lyndsay said, I'm Amanda. Amanda Gotch. I am the realistic medicine programme manager for NHS Grampian and NHS Orkney. We actually have a collaboration with Orkney. We started that just around early this year, early 2022. And I will go into a bit more detail about that as Lyndsay and I chat. I am a midwife by clinical background. I've been a midwife for a very long time, but I really kind of came around to doing this work as a programme manager for Realistic Medicine after undertaking the Scottish Quality and Safety Fellowship. I Heard about Realistic Medicine whilst on the fellowship and thought, well, that makes sense to me as a midwife. So really, from there, when the opportunity came up to be the programme manager at the time for Grampian, I absolutely jumped on the opportunity and here I am.Lyndsay: Absolutely, yeah, it's a bit like myself. So when I saw the post for the program manager for Realistic Medicine come up with my background, I look on a daily basis at the evergrowing waiting list within every hospital in Scotland, not just ourselves or with yourself in Grampian. And, you'll know, and the amount of times that I've seen patients who sat on a waiting list for weeks and weeks, then when we had capacity, we would call for the patient. And I can't stress the amount of times we had patients on the phone to us saying, oh, I don't know why I'm on the waiting list for that procedure. Or we'll phone them and say, yep, we're going to call you and you're going to come in for your colonoscopy. And when we say to them, you know, you'll have four litres of bowel prep what the procedure actually is straight away, they're going, oh, I can't do that, I don't want to do that. And if they used realistic medicine at either a clinic appointment or at the GP appointment and said, this is what might happen, you can have that conversation there, and then to the patient to say, you know, this is what to expect, there might be an alternative that they can do, but also, if there is no alternative, you're giving the patient the right information to prepare themselves. I know myself, I'm terrified of the dentist and I had to go for my first filling and I had a nightmare for a week until I actually asked the question and it put my mind at ease. So I think it makes sense. It absolutely makes sense.Amanda: Yeah, absolutely. And I think that shared decision making and personalized care with the kind of two of the six principles that spoke to me most, lindsay as well, and I think, again, not just as well, yes, as a midwife, but also as a human being. And you're right. It is that we always imagine the worst case scenario. Don't we. When we've got to go through something and it might be bad. It might be bad. But being able to have the opportunity to prepare for it and at least start to maybe understand a bit more about the things that could happen and the things that definitely won't happen. It goes a long way. I think. To helping make people make decisions. And we do know there is evidence out there that when people are given all the information to help them to make a decision. They usually choose the most conservative option as well. Which I think is especially in today's healthcare kind of landscape that we're looking at. I think that's something we need to be aware of. That. You know. Like you say. Those people you phone up that say.Lyndsay: Oh. No.Amanda: I don't know why I'm on that waiting list. That's some work we're going to be doing in Grampion. We've just been awarded funding in Grampian and in Orkney to look at why people are unnecessarily put on waiting lists. Why are people added to these? What is that? Is that just in case? Is that just we need to feel like we're doing something. I'm ...
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    25 分

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