Realistic Medicine: Changing culture and practice in the delivery of health and social care

Fenning, Stephen; Smith, Gregor; Calderwood, Carmelita

doi:10.1016/j.pec.2019.06.024

Cited by 18 publications

(12 citation statements)

References 7 publications

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“…Therefore, general practice must define its own holistic approach to chronic care including an independant terminology (Bodenheimer, 2006; Crabtree et al, 2020; McWhinney, 1997). Guidelines for general practice should include the patients’ perspectives and the patients’ shifting priorities (Arreskov et al, 2018; DSAM, 2020) without losing sight of biomedical parameters and evidence-based medicine (DSAM, 2019a; Fenning et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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

2021

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We investigated general practitioners’ (GPs’) responses to patients’ concerns in chronic care consultations. Video recordings of 14 consultations were analyzed with conversation analysis. We found two categories of responses: exiting and exploring the patient’s concerns. Most GPs exited the concern by interrupting the patient, acknowledging the concern but then referring back to the progression of the consultation, or affiliating with the concern without exploring it. Only a few raised concerns were explored, and then most often the somatic rather than the emotional aspects of them. The findings point to the risk of missing patients’ voiced concerns in consultations with a fixed agenda.

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Section: Discussionmentioning

confidence: 99%

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

2021

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“…Indeed, one-fifth of patients felt they were not given the opportunity to make decisions regarding their own healthcare including non-operative decisions. To help surgeons, we suggest familiarization with shared decision-making guidance from the King's Fund and also the Scottish Government's 'Practicing Realistic Medicine' to provide a communication framework in decision-making and alternative treatment options [27]. Regarding surgeon personality, more research is necessary to explore the interactions between decision-making, personality traits and postoperative colorectal surgery outcomes, a need expressed both by patients in this study and by the Association of Coloproctologists of Great Britain and Ireland's Research Prioritization Delphi Exercise [11,28,29].…”

Section: Discussionmentioning

confidence: 99%

Exploring shared surgical decision‐making from the patient's perspective: is the personality of the surgeon important?

Bisset

Dames²,

Oliphant

et al. 2020

Colorectal Disease

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Aim The aim was to determine the importance of a colorectal surgeon's personality to patients and its influence on their decision-making. Methods We present a two-part mixed methods study using the Guidance for Reporting Involvement of Patients and the Public (GRIPP-2) long form. Part 1 was an online survey (25 questions) and Part 2 a faceto-face patient and public involvement exercise. Part 1 included patient demographics, details of surgery, overall patient satisfaction (net promoter score) and patient views on surgeon personality (Gosling 10 Item Personality Index). The thematic analysis of free-text responses generated four themes that were taken forward to Part 2. These themes were used to structure focus group discussions on surgeon-patient interactions. Results Part 1 yielded 296 responses: 72% women, 75.3% UK-based and 55.1% aged 40-59 years. Inflammatory bowel disease (45.3%) and cancer (40.2%) were the main indications. 84.1% of respondents reported satisfaction with their surgical experience (net promoter score). Four key themes were generated from Part 1 and validated in Part 2: (i) surgeon personality stereotypes (media differed from patients' perspective); (ii) favourable and unfavourable surgical personality traits (openness, conscientiousness, emotional stability preferred over risk-taking and narcissism); (iii) patient-surgeon interaction (mutual respect and rapport valued); (iv) impact of surgeon personality on decision-making (majority unaware of second opinion option; management of postoperative complications). Conclusion Patients believe surgeon personality influences shared decision-making. Low levels of emotional stability and conscientiousness are perceived by patients to increase the likelihood of postoperative adverse events. Further work is required to explore the potential influence of surgeon personality on shared decisionmaking and postoperative outcomes. Keywords surgeon, personality, patient and public involvement, PPI What does this paper add to the literature? This is the first study to explore patient perceptions of the influence of the surgeon's personality on shared decision-making. Patients believe high levels of openness, conscientiousness and emotional stability are positive personality traits in surgeons and believe that, if lacking, the management of postoperative outcomes can be negatively influenced.

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“…Other national initiatives that have sought to address overuse include Realistic Medicine (Scotland) and Prudent Healthcare (Wales). These national healthcare strategies 114,118 provide overarching principles 119 around which a wide range of improvement activities (more or less geared to overuse) have been aligned. The principles emphasise that many patients prefer less intervention than they receive and stress the need for improved shared decision-making (see Box 5).…”

Section: Box 3 Choosing Wisely and Other Uk Campaignsmentioning

confidence: 99%

Reducing Overuse

Cupit

Tarrant

Armstrong

2023

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Overuse has become a major issue of healthcare quality, safety, and sustainability around the world. In this Element, the authors discuss concepts, terminology, and the history of concerns. They show how interventions to address overuse target multiple drivers. They highlight successes and promising approaches, but also challenges in generating and using evidence about overuse. They emphasise that different stakeholder perceptions of value must be recognised. System-level efforts to restrict access to services have created tensions between stakeholder groups and stimulated politicised debates about rationing. They argue for clear articulation of priorities, problem definition, mechanisms for interventions, and areas of uncertainty. Policy-makers should prioritise transparency, be alert to inequalities as they seek to reduce overuse, and consider how to balance controlling use with enabling clinicians to respond to individual circumstances. The complexity of the drivers and possible solutions to overuse require the use of multiple research methods, including social science studies. This title is also available as Open Access on Cambridge Core.

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Realistic Medicine: Changing culture and practice in the delivery of health and social care

Cited by 18 publications

References 7 publications

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

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

Exploring shared surgical decision‐making from the patient's perspective: is the personality of the surgeon important?

Reducing Overuse

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