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  • Complex decisions, shared; Dr Suzie Farrell & the Shared Decision Making clinic.

    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.'

    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

    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
  • Health Literacy with Dr Graham Kramer

    Health Literacy with Dr Graham Kramer
    2022/10/03
    Kate: Welcome to the Realistic Medicine Podcast. We are taking full advantage of Health Literacy Month, and we are delighted to welcome Graham Kramer here to talk to us about about health literacy. So I'll start by introducing myself and Kate Arrow. I'm the clinical lead for realistic medicine in Highland. And then thanks so much for joining us. Graham, can you tell us a little bit about yourself?Graham: Yeah. Thanks, Kate. And thanks for inviting me to take part in this. I'm a recently retired GP. I retired August last year, having spent most of my career as a GP in Montrose on the East Coast in Tayside. And I suppose I spent a lot of time in general practice with a big interest in people living with long term conditions. And for a few years in the latter half of my career, I was seconded to Scottish government as a clinical lead for self management and health literacy, kind of terms that are slightly confusing and people struggle to think what those might mean. But at the heart of it, it's really enabling and supporting people to be the sort of lead partner in their care, because we know that when people are the lead partners, when they're the active agent in their encounters with healthcare professionals, often health care outcomes are better, people make better decisions relevant to themselves when these sort of things happen. So there's a big political economy around supporting people to self manage, and a key ingredient to that is people being able to understand and engage in their own health and health care. And that's where some of health literacy comes in. And this is very important.Kate: Grand yeah, because it's a term that we talk about a lot. And it became clear to me recently that not everyone fully understands what health literacy means and how they can improve health literacy. Can you kind of explain to us what it is from a clinician point of view and maybe from a patient's point of view?Graham: Okay, that's interesting. I think there are sort of a few definitions of health literacy, and I just recently reading a paper, which was a whole paper discussed to sort of teasing out the various definitions of health literacy. It's really complex and I thought it would be disingenuous, but I think some of these are very good definitions. But I would argue that they suck. And I mean suck as a Mnemonic with S standing for skills, u standing for understanding, c for confidence, and K for knowledge. I think fundamentally, health literacy is about people having the skills, the understanding, the confidence and the knowledge to do what? To access and navigate the healthcare system, to be able to collaborate with their health care professionals, and I suppose, finally, to be able to self manage their own health and their health conditions in the way that they would want to necessarily force our treatment, some people. So that's sort of I think a light way of understanding that it's just remember the mnemonic suck skills, understanding, confidence and knowledge. There is a problem with these definitions because they often locate the problem with the person. So we might argue that people have insufficient skills and understanding, confidence and knowledge. And I suppose there's this great temptation to sort of really try and improve that, improve their skills and understanding and give them knowledge and things like that. And that's very important. But it's also a challenge for us to make healthcare much more easier to understand and more accessible and easier to engage with. I guess sort of in the evolution of the development of health prevention, health promotion, particularly in the old days where perhaps the biggest health problems were infectious diseases, communicable diseases, and health education was really important. So health literacy sort of was conflated a bit with health education. Now I think we're moving where people living with long term conditions. It's not really just the responsibility of public health teams. It really impacts us clinicians on how we engage with people and the onus for us to make healthcare much more understandable and engageable. The analogy, just a brief analogy that I've always used often tell this story, is 40 years ago, none of us had any computer literacy. We didn't really understand how computers work. And of course, IBM produced the first computer, which was this massive clunky thing which would have filled half your living room. And you would have had to have been an uber scientist or a geek to really want to be able to engage with one of these. And of course, what the computer industry could have done is they could have educated us all. They could have given us books and pamphlets to read about how to use these computers and how to code. They could have sent us off to evening classes. But in fact, what they did is they made computers a lot more engaging and simpler to use. And now, whether you're five or 85, using an iPad is so instinctive. I guess that ...
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    34 分
  • What is Realistic Medicine?

    What is Realistic Medicine?
    2022/09/20

    Welcome to the Realistic Medicine podcast. See the transcript below;
    Kate: Hi, I'm Kate Arrow and I'm the clinical lead for realistic medicine in NHS Highland. In this podcast we'll introduce our team both locally and nationally and share our work with you. There will be something for everyone from sharing learning, to hearing about our community, our colleagues and the third sector. So what is realistic medicine? I went to speak to the Highland Senior Citizens Network last week and when I asked this question, very few people knew. So we've got a lot of work to do. But in essence it's a set of principles which aim to put the patient at the heart of their care. International evidence confirms that shared decision making and personcentered care improve experience, reduce harm, reduce waste and reduce risk. We know that patients often do not have time or do not feel supported to ask questions about their care. This means it can be difficult to empower them with the correct information for them to be able to digest and make the right choice for them as an individual. Our aim in Scotland is to support people to live the best quality life for as long as possible. This means we have to understand not only what help they seek for their health condition, but also what matters to them and their expectations and goals of treatment. When I spoke to the Highland Senior Citizens Network last week, I heard that their community often feel like a burden. They find it difficult to access services and their experiences vary depending on where they live. I'm going to share some quotes from them. Doctors see me as illness minus my life and wishes. It's difficult to have a conversation and you feel like you're passed around the houses. I don't feel confident to ask questions. Carers aren't valued as advocates, but they are closest to me and should be listened to. I don't feel seen or heard. There's an imbalance of health and social care that doesn't allow them to talk the same language. I feel that I'm not listen to or believed and I don't know how to get access. Now these are just some of the comments and there was a lot of great positive ideas for change and really great conversations. But these quotes all relate back to Realistic Medicine. If we can all practice Realistic Medicine, we can see that we can improve the experience of many of these individuals. And over the series of this podcast, we will go deeper into the evidence behind Realistic Medicine. We'll look at initiatives and innovations which are supporting its practice across Scotland and Highland, and also meet our colleagues and patients to hear their stories and to hear from people who are really embedded in Realistic Medicine in their practice. In our next episode, we will hear from a few of our Realistic Medicine program managers to hear about some of the fantastic work they're progressing, what their roles involve and what they are learning as they go. Please listen to this episode and to our show as we move forward on this journey with our podcast. And if you would like to be involved or share your experience, please email myself or the generic realistic medicine Highland email address, which is in the show notes nhsh.realisticmedicinehighland@nhs.scot . Bye for now.
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    4 分