1. Consultant in Palliative Medicine Marie Curie Hospice Edinburgh
Realising Realistic Medicine
Implications for Palliative and End of Life Care
Dr Juliet Spiller
Consultant in Palliative Medicine
Marie Curie Hospice Edinburgh

2. Realistic Medicine is clearly not all about Palliative Care
But Palliative Care is, and always has been, about Realistic Medicine
Values, shared decisions, person-centred, individualised approach, focus on what matters to you, benefit/burden balance
Those who choose to specialise in Palliative Care have this at the core of all they do.

3. Palliative Care is everybody’s job – “no time”, “no knowledge”, “something extra/different from my job”
Realistic Medicine is everybody’s job – makes more sense particularly caring for people with long term and life-limiting conditions – “yes that’s my job”
Realistic Medicine - opportunity for SPC to explicitly support:
- “mainstreaming” of a palliative care approach
- Creative ways to engage with experts (patients, carers and volunteers)
(eg “Building the Best”, “ Hospice without Walls” etc)

4. Realising Realistic Medicine - PEoLC
IDENTIFICATION of palliative need - SPICT, SPARRA etc
EQUITY
Postcode, diagnosis, culture etc
HEALTH LITERACY –shared understanding (trust, empowerment, enabling decisions)
EDUCATION
Patients, carers, clinical staff, volunteers, social carers, care home staff etc
ANTICIPATORY CARE PLANNING
National ACP, ReSPECT, KIS etc
RESEARCH – what works, patient experience, carer experience, sharing good practice

6. “This case was never really about the decision-making process, that didn’t really come up at all. It was - why didn’t they talk to my mum . Why didn’t they explain to her what was possible? Why didn’t she get the chance, when she so desperately wanted it, to talk about what was going to happen?”
Kate Masters – daughter of Janet Tracey – explaining why her dad pursued the case against Cambridge University Hosp Trust

7. Step change not marginal change
‘You can make incremental change, you can improve, by
asking everyone to do two jobs, to deliver performance,
using current measures, and to improve, and you can
do the improvement in 5-10% of your job, and delivery
in the rest. But if you’re asking people to do new job
descriptions, new teams, new ways of communicating
it’s too much to ask for people to do in 10% of their
time; and no-one can do it alone.’
Dr Albert Mulley, Director for Global Healthcare Delivery Science
What types of studies have been undertaken (designs used/characteristics of the study populations).

8. Realistic Research
What types of studies have been undertaken (designs used/characteristics of the study populations).