Scotland needs to move towards a culture of “realistic medicine” with doctors urged not to over-treat patients, the chief medical officer has said.
In her first annual report on the health of the nation, Dr Catherine Calderwood urged medics to discard the ‘doctor knows best’ approach and to discuss treatments more with their patients to tackle the “massively increasing volume of medication taken by the population each year”.
Dr Calderwood, a consultant obstetrician and gynaecologist, cited increases in available medicines and a rise in public expectations as major factors leading to over-treatment.
One in five adults in Scotland is taking more than five medications daily, which increases the chances of unwanted side effects and a significant risk of harmful consequences such as falls, confusion and hospital admission, the report said.
Doctors leaders welcomed the report but warned that it was a challenge for doctors to find the time to innovate and morale was low due to rising workloads and high vacancy numbers. Dr Calderwood said: “In striving to provide relief from discomfort, illness and death, modern medicine can sometimes over-reach itself and provide treatment that is of little long-term benefit to the patient.
“This is especially true when a person has multiple conditions, each of which has its own list of recommended medicines and treatments.
“Realistic medicine is about moving away from the ‘doctor knows best’ culture. It’s about more fully involving patients in the decisions about their care. Of course this will only happen if people are prepared to have these conversations in this way with their doctors.”
The report also summarised data on Scotland’s health, highlighting inequalities in areas such as obesity, cancer mortality and smoking rates.
Dr Peter Bennie, chair of British Medical Association (BMA) Scottish Council, said: “It is good to see Dr Calderwood acknowledge the critical role doctors must play in shaping how medicine is practised in the future and how healthcare is delivered, to secure high quality patient care and the overall health of our nation.
“But whilst doctors can play a vital part in supporting the development of new approaches to healthcare models we must recognise that morale amongst Scotland’s doctors is very low with workload intensity continuing to rise, and that this is likely to have an effect on how well doctors can respond to the needs of a changing health care service and growing patient demand.”
Tackling health inequalities and improving healthy behaviour will play a key role.