Guidelines in the Era of Realistic Medicine

General practitioner responses to concerns in chronic care consultations for patients with a history of cancer

“…Chronic care consultations could, due to their regularity, be an obvious opportunity for recognizing and talking about emotional concerns (Finset, 2012; May et al, 2004). However, when GPs stick strictly to guidelines with a biomedical focus, the consultations get a pre-defined content that risks conflicting with the patient-centered approach, thereby disregarding the patient’s needs, matters of concern, and situation (Austad et al, 2016; Kinsella, 2016). In order to conduct patient-centered chronic care consultations, GPs should not only fulfill the goals of the biomedical guidelines, but also be open to the patient’s concerns, which might be related to the disease or to more existential or mental issues.…”

Commentary: Back to the future in cervical screening: applying a contemporary lens to an old controversy

“…We know that overdiagnosis can cause harms in terms of anxiety, depression, labeling, financial burden, and treatment side effects. There is a strong push through initiatives such as realistic medicine [5] to reduce overdiagnosis and make clinicians and organizers of screening programmes more aware of the issues [6]. In many ways, overdiagnosis is an inevitable feature of health care systems which seek to diagnose and mitigate disease before it has any clinical relevance; the Herb Green case prompts us to think about the way we view precancerous lesions and our natural instinct to treat them, even when the evidence for doing so does not measure up.…”

Personalised Approach to Anticoagulation

“…We were pleased to read of the integration of SIGN into Healthcare Improvement Scotland so as to take advantage of their health economic expertise. 1 The new team may wish to reflect on the review in the same journal issue of the use of direct oral anticoagulants (DOACs), formally known as NOACs, as an alternative to warfarin. 2 Though well researched in terms of the details on use of DOACs, there were a number of oversights.…”

“…We are exploring the feasibility of this 'personalised' approach in Newcastle with other centres in development. 1 J Burn, 2 H Sheth 1 Professor of Clinical Genetics, 2 Research Fellow, Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK Email john.burn@newcastle.ac.uk…”