Catherine Calderwood: champion of “realistic medicine”
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5455 (Published 11 October 2016) Cite this as: BMJ 2016;355:i5455
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Also, I would like a doctor who is not only a talented physician, but a bit of a metaphysician, too. Someone who can treat body and soul. Anatole Broyard
Realistic medicine needs to be laminated by empathy, warmth, and genuineness. Being “heard and accepted” - like communion - goes beyond an intellectual understanding of the patient's need and mind. It makes it necessary to develop a relationship that links the patient, at a minimum through the doctor-patient relationship, allowing the physician to think like the patient. It will develop a connexion-nexus between the patient-physician. A transpersonal relationship between the patient and physician will be the first dimension to be established before we start treating the patient. It may appear utopian when the physician in some countries do not even have the luxury of that human touch that creates trust due to the number of patients they see per day.
Some of the barriers listed for communication between the patient and physician are as follows
*Foreign language spoken
* Dysphonia
* Time constraints on physician or patient
* Unavailability of physician or patient to meet face-to-face
* Illness
* Altered mental state
* Medication effects
* Cerebral-vascular event
* Psychologic or emotional distress
* Gender differences
* Racial or cultural differences
It is suggested to overcome these barriers a physician may need to 1. know what the patient already knows, 2. what the patient needs to know, 3.Be slow, 4. be empathic, 5. anticipate reaction, 6. tell the truth, 7. study the body language of the patient, 8. keep it simple, 9. be hopeful.
Choice of words, information depth, pattern of speech, body position, and facial expression (body language) can greatly influence the patient-physician relationship. These learned behaviors along with what we define as realistic medicine can pave the way for a therapeutic model that may meet the needs of the patient and well-being.
Competing interests: No competing interests
Re: Catherine Calderwood: champion of “realistic medicine”
Dr Calderwood's lead in this direction is welcome in an NHS where corporate needs have perhaps seemed more influential than those of individual service users. To offer meaningful choice to patients, Positive Realistic Medicine requires the provision of effective alternative treatments when avoiding unnecessary over-medicalisation.
To progress her ideas, we suggest that she identifies areas of General Practice where doctors and some patients are already uneasy about pharmaceutical approaches and would value effective alternatives (listening for preferences requires realistic alternatives).
For example, the Snakes and Ladders trauma resolution approach to anxiety in General Practice has been effective and efficient in Scotland based on observations of common pathways for trauma and its recovery, (1) with audit data reduction in the anxiety score of HADS by an average of 7.4 points following only two sequential 10 minute interventions, one to two weeks apart, thus reducing prescribing pressure on the doctor and being well received by patients who, as Dr Calderwood duly noted, prefer less intervention.
Use of vestibular physical therapies (2) as alternatives to long term prescribing of labyrinthine sedatives would also increase patient choice to promote realistic medicine.
As CMO, Dr Calderwood is ideally placed to seek and publish realistic alternatives for listening doctors to offer patients who would prefer a choice. We look forward to responding to her call for papers.
(1) Dutton, P.V, Ashworth, A.J. The natural history of recovery from psychological trauma: An observational model. Medical Hypotheses 85 (2015) 588-590
(2) http://www.dizziness-and-balance.com/disorders/bppv/home/home-pc.html
Competing interests: No competing interests