Our preferences matter. Recently, a friend of mine was house-hunting and we were looking through photos of properties on the market. One house, in particular, caught my eye. It looked beautiful, was the right size for her family and was within her budget. In my mind, the perfect place.
But my friend was less keen. It wasn’t that she disagreed with me about its appearance or its size or its affordability. Quite the opposite. But she told me that “it just wouldn’t work” for her family. What I had failed to take into account was its location – a lovely neighbourhood but too far away from her elderly parents and her husband’s workplace. It was perfect in almost all senses but it just didn’t fit with her life or the lives of those she cared about most.
The same is true in healthcare. Yes, the care and treatment provided by our NHS must be safe, of high quality and based on the best available evidence. But, wherever possible, it must also fit with our lives. It must be given to the right people at the right time and in the right place. It must be sensible and practical. In short, it must be realistic.
Without this, even high quality care can be of low value to the person receiving it – like the dream house in the wrong location.
Today, I published Personalising Realistic Medicine, my fourth annual report as Chief Medical Officer for Scotland. In my report, I call for our health and care system to build a personalised approach to care. I want our professionals to find out ‘what matters to you’ and not focus simply on ‘what’s the matter with you’. Only by doing this will we better understand how someone’s disease and treatment fits into the overall picture of their lives. Only then can we provide the care they value. In the words of Hippocrates, “it is more important to know what sort of person has a disease than to know what sort of disease a person has”.
We must also seek to minimise the impact of healthcare on people’s time, energy and attention. Attending hospital appointments, undergoing tests and procedures, and receiving treatments can be inconvenient for those of us who are busy, or who live in remote and rural areas. It can be exhausting, particularly when we are feeling less well or without others to help us.
Of course, in many cases, appointments, tests and treatments are welcome. They are what we need to feel better. But are they always necessary? Or are there other options that would fit more appropriately with our lives?
I am not suggesting the NHS should always give us what we want. There are times when this may not be appropriate, or indeed practical. For example, when there’s not enough evidence that a treatment is effective or safe.
But our NHS should always be thinking creatively about ways to be kinder to us as patients. Does this appointment need to be face-to-face or can it be done differently and spare someone a long journey? Can we take more time to find out what matters most? Can we communicate medical information in non-technical language that everyone can understand?
So, as I launch my latest annual report, I urge all health and care professionals to listen to people’s preferences and find new ways to make care fit into the context of our lives. These are the features of a realistic and personalised approach to care. This is how our NHS will deliver care that people truly value.
Dr Catherine Calderwood is Scotland’s Chief Medical Officer. She is grateful to her clinical fellow, Dr Stephen Fenning, for his contribution to this article.