 Felly, we have published to have her to speak to us tonight on the philosophy of realistic medicine. Dr Colew. Good evening everyone and thank you very much to Geoffrey and to Cora for the kind invitation to speak, particularly since this is your first meeting of this season. The Chief Medical Officer is also an honest station and I'm the only Chief Medical Officer ever to still sit patient. Also I've brought female Chief Medical Officer in Scotland. I have 3 children and-. My children are used to understand what I did for a living. So I went to work to help the little ones who weren't having that baby. But when I got this new job, my son and I were walking into school together. He was holding his hand and he was saying to me, ''It's your job, not yours, It's all about keeping people healthy isn't it? I said, this is a struggle this. It's like, not in a bad sweet side. I said no George, I'm not. Also on that bit of a wine. Don't sit back publicly. So, one of the roles of the chief medical officer is to write an annual report every year. And that annual report is a snapshot of the health of the nation. Ond oedd yn cyfgaredd, oedd y cyfgaredd, oedd yn cyfgaredd hynny'n gwybod â'u gofynaldig ar gyfer allan nesaf gallai trofyn ynりwch, trofyn yn byw, trofyn yn gofynno'r gofynno ar gyfer allan. Ond dyna'r holl y cyfgaredd, oedd pob ei gynnig, fel sydd yn sgolfa yma o'r rhaid, ond hefyd â'i vaf a'r holl ysgrifennu o'r holl ysgrifennu yn ystafell. I wrote an open letter to the medical profession in Scotland and asked then if the fact is medicine differently. I want a letter that makes them different. When I was going out and about around the country, I was hearing from my medical colleagues that they were not feeling that the medical profession was being listened to. ac byddaethau cwmydd hynny yn cael wahanol arno. Byddaethau'n mynd i gael hynny'n ddefynio'r cwmydd ac bydddaethau'n mynd i'r ddyn nhw'n bwysig a'u bwysig i ddim yn diogel i'r hwn. A'r bysgol yn mynd i'r llunydd refugees yn meddwl sydd wedi'u meddwl i meddwl ystod i'r meddwl oedd yn ysgweithio'r meddwl meddwl yma. Mae'n rwy'n meddwl i'w meddwl i'w meddwl i'r meddl ymdill yn ymddill y gallwch yn edrych o'r lluniau o'r hunain yn oed. Mae'r dda i'n dda i ddim yn gweithio y ffaint oedd gael eu hunain i gyntafol ar gyfer y byddwch oed yn ymddill i gyfnoddol oherwydd o'r ddechrau. Yn y ffaint, mae'n ffaint yw mwyaf yn rhaid i gwneud y ddechrau'n bryddol, fel y pwyllfa, ymddill, ymddill, ymddill, ymddill, ymddill, ymddill, ymddill, ymdill, ac mae gennych i gael y gwagol yn y cyfnod yn y cyffredinol. Cymru yma ymlaen i'r gwneud y profiad yng Nghymru, yna cynnig i'n ymdwy fydd yn digwydd yn y cyffredinol. Mae hynny'n mynd i'r ymdwy'r ymddwy fydd yn eu cyffredinol, yn ychydig i chi'n gweithio i'r syniadau, ac i'n bryd ymddwy'n gwybod ychydig i'r cyffredinol. Felly rydyn ni'n debyg chi'n mynd i gwybod ar gyfer hynna o'r stori, The first story is about a man in Ayrshire. I went to Ayrshire and this man came forward to be introduced to me, and he spoke to me and said he recently had a new work place. I said, hello. How's it with you? Please look Rwyf i'n deall. Rwyf i'n deall. Rwyf i'n deall. Is it not as it not working on your campaign? Well, you see doctor. You didn't really want a new name. What was it you wanted? I wanted a Grab Rail. So you wanted a Grab Rail. Yes because I like to stand on my doorstep and speak to my neighbour and my needs am hynny'n i amser y grath yma i'r lot wedi'i gwneud. A mae'r Ddiddor wedi'u hynny, gallwn ei gael ar gyfer grath. A dyfodol gennym ni eich rhaid i ni'n gwahon ar y plain deillogol. Oni yn f wrestlingo haf am oedl. Gael eu rhaid i rydych chi'r llwylo'r llyfriddor yma oherwydd y gwirionedd i gael o'r llyfriddor o'r llyfriddor yma i'r llyfriddor, ych chi'n meddwl a'r llyfriddor yn fawr i'r llyfriddor, The necessity of aneu replacement but actually that wasn't what that man asked for or did that man get of whom he was actually prioritising. I'll tell you about it. This is about a man in lan air皇. Now this man has an unusual hobby as you can tell, he also has a pigeon fancier slung perhaps unsurprisingly. Mae Llywodraeth wedi gweld arnoedol o gyveld, mae wedi defnyddio'r bod yn trefio'n penedig, yn ymgyrch, yn ymgyrch, fel hwn yn yr hyn, sgwp. Byddwn yn ymwllteisio'n ceis. mae rhaid i unrhyw apoddiadau arnoedol o'r gyfer. Felly, yr adeg Llywodraeth wedi gweld o'r cymryd, byddwn yn ylad i'r gweld Lerwch Gwrthomau, yw'r adeg Halladol fyddi, ydw i'ch sgwp ei wneud, I gynnydd i'r maen nhw'n blyneddau sy'n gweithio i ni'n gwneud i fynd. Rai umswn i'n gweithio'r hosbedd yma Rai umswn i'r maen nhw. Mae'r cyfnod yn ôl i'r newid yn gyda i'r cyffredin, mae'r chyfodd, mae'r iawn er mwynhau'r cyffredin, mae'r cyffredin, ac mae'r cyfan o'n gwerthu'r ei gael i'r meddwl. Rai umswn i'n gweithio, roedd yma'n gweithio i'n gweithio i'r hosbedd. So, he decided to go out and visit the man, and nobody had ever been in this man's heart. Graham went in, interviewed him, yes indeed he was very breathless, probably he needs to be admitted to hospital. And Graham started the conversation with him about the pigeons. You can tell where this conversation will be going. Well, you do realise that your lungs are really worse because of the pigeons. You do realise that if you got rid of the pigeons, you would stop deteriorating, you wouldn't be admitted to hospital, you might live longer. And you would see my daughter in the corner of the room sort of deafening out. So he stopped the conversation about giving up the pigeons. And I told him, I think Doctor, you might like to see my father's back room. So these pictures aren't very clear because this is a tiny little room. And you'll see that those trophies, those pictures are portraits of his pigeons. He has a portrait of every winning pigeon and everybody is asking that they stop winning. He is actually, at one time, was the UK's best pigeon racer. And those sheds that you can see in the bottom corner has taken two to three hundred pigeons. And his prize-racing pigeon was sold for £30,000. So what did the daughter say to Graham? Doctor, he's not giving up his pigeons. Will you stop asking him to do that? He would rather die than give up his pigeons. He goes to the hospital every six months, they're given the lecture about the pigeons, he comes home, he goes back into the sheds, he stays with them, he talks to them, he sees them, he loves them for two or three hours every day. So I wonder, when I ask people, what is it that is the priority that we can give medicine to this man? And in fact, Graham kept him at home, he hooked up the anti-antibiotics to the sound of lamp in the sitting room, he gave an injection of iodine hydrocortisone and left him at home to be looked after there. But do we really talk to people about what their priorities are? Do we really enable people to have that personalised care? I wonder that Alistair tell his own story. Caroline is a real physician in Edinburgh and Alistair means to tell us his story. Well, I would say that my current medical condition has not been completely lost in the last few months. At that point, every after this year, at the very end, where I will be, at the moment, I am much surprised at how much I have improved after the treatment and I have improved my arm. And I resolved that in my opinion to close consultation with other specials, the VIP book, for example, to look into a very deep decision between you and yourself, and the quantity of my current situation, because I thought I was going to fall off the edge of my mind. What is the scene? We discussed it with the team. I was going to say, well, it's that kind of a unit at night. For a long, you know, life, at a similar extent, Alistair happened out of the shock, and the quality of life rather than just dragging on and the same old drugs and everything else has decided to come off his walk and not be eating in the evening, just to be off right now, is it? And there's also Andy Lluver on which a pharmacist can tell me that my own pain is the same of poison. So I've come off Andy Lluver on... ..and I was given another one to control that bump in my stomach. And since then, I've been doing the VIP. If you're a little tear at the point that the answers might be considered in another portion of that very important question, what's your understanding about the answers and what's the relationship with what's in there? Well, I've been working with a lot of people and having their house and it's not... I've been living with a certain number of people and I've been interested in the facts of everything, but then, in the goodness, actually, I don't know what I'm going to know, but that's me at the goodness. I don't know how to put it. I don't know what to do with the second day in a year. I've had so many things wrong. My doubts were just bad, you know, a whole bunch of things I know. You've sometimes talked about shared decision making. Is that something you recognise that's happening in New Yorktown? I wish you I don't know. I thought it was good to make a shared decision between my consultant and doctor and that has been all I've ever seen. And you have that under pressure not to have a particular treatment? No. Mae'r ddechrau wedi bod wedi bod yn maith i'n dwyliadau yw'r hyn sydd yn y pethau oherwydd yn y dyfodol, ac mae'n gweithio gyda'r cyflwyno'r cyfrifiad. Mae'n ddweud y byw, byddai'n blyneddol gyda'r cyfoedd. Mae'r cyfrifiad? Mae'n ddweud, ond mae'n meddwl i'r lleidio'r gyfrifiad, ac mae'n ddweud, ond mae'n meddwl i'n meddwl i'n meddwl i'r lleidio'r cyfrifiad. Mae'n gwineb y gallwn mynd i'wicketwyr. Mae'n gynnwch yn hynny i wneud hyn ar draws i'w gael y mynd yw'r iawn i gyda'r afael. Mae'n cael i ei modd arweinydd. Mae'n bryd i hynny i bryd. Mae'n gweld ar hynny y gwirionedd dweud. Mae'r gwirionedd arweinydd y byd. Mae'n gweld arweinydd arweinydd arweinydd arweinydd i'w gwirionedd arweinydd arweinydd. y bydd y dyma yng Nghymru yn ystod o'r plen. Ond efallai, mae'n ddechrau'n gwneud hynny. Hallys, mae'r cwestiynau cynllunio dialeisus cynnig yn hynny. A'r cwestiynau cynllunio dialeisus yn hynny yn ymgynnu hynny, mae'n ddylai'r cyngorol yn ddechrau'n cymhwytaid. Ond y ddwylltyn hwnnw? Dydyn ni wedi sicr hanfod y mynd i ddull. Rydyn ni wedi'u air a'r dyfentydd i gael pob diwylltu i'r rhai gweithio'r ddweud. Rydyn ni wedi'u ddweud o'i wneud o'r adithau'r cyllidiau oherwydd mae'n rhai gyd. Mae y发hau ar Dreaming fel oed yn oed. Mae yn eich bwysig yma, a phobl y gallwn oedd aeth gwael. Mae'n gweithio'r siwr. Mae'r ddwyllteithio'r gwlad i'r awr! Mae'n gwlad i amser. a dwi'n dweud ychwanegwyd yn gweld fyw yw'r rhan o'r cyfnodau a'r ddechrau i ddim yn dweud. Llyr Gruffydd yn rhywbeth yma yn ymlaen o'r cynllun o'r ddweud. Rydym yn rhan o'r rhan o'r gweithio ar gyfer ddechrau ac o'r ddweud o'r ddweud o'r ddweud o'r ddweud. BUT THE END OF MY 88% OF DOCTORS WOULD NOT HAVE PEOPLE DIAUSES ISeptificated Dysak. 95% of DOCTORS WOULD NOT agree to have sleeping air to be resuscitated in the event of aUsER ADAPT. 67% OF DARTORS WOULD NOT BE AVOIDED TO INTERINZED CARE AF THE END OF THEIR LIONs. AND THAT MAD YOU THINK OF WHAT IS IT THAT I KNOW WILL MAKE ME ACT DIFFERENTLY TO WHAT PEOPLE DO FOR THE PATIENT Yn dechrau yn ffordd, mae'r bwysig wedi bod ni o'r bobl yn ymweld y mynd i'ch colli. A rydym yn dda'r bobl yna d weaknessol er holl. Mae'r bwysig yn ymgyrch tychfnwyr neu ddweud gyfrindwyr – mewn mynd thisfyr na bwysig – a fyddwn ni wedi'n ymgyrch ar bobl a'r bobl yn ymwybodol. Mae'n bwysig i teimlu o'r bobl yn gŵr i'w bobl. Mae'r bobl er bod ni'n bwysig i'chwyn bod ni'n brif yn grŷg. felly mae'n gwneud arall, efo'r rhaid yn hawdd, yn dderbyn arall, i wneud ar y lluniau, i ddweud bod chi yn ei wneud, yna sy'n gweithio. A blaen i'r byw ychydig mewn passeid. Ym ni'n gweithio sydd ei wneud ym ni'n gweithio yn gwneud. Ym ni'n gweithio, bod ym ni'n gweithio'r gweithio'n gweithio'n gweithio'n gweithio'n gweithio. Imen reliable, and secondary, I want to spend time with my family. So, what is it about the disconnect between what the沒錯 profession and the other healthcare professionals are doing, that actually isn't necessarily what the people were looking after were asking us for? The third thing that happened was the Montgomery ruling, which is a legal ruling following the delivery of a baby who has severe disabilities, in amateur, some 16 years ago. That court case has just come through. In about two years ago that lady had a big baby, she had diabetes and during delivery the baby got stuck. There was a degree of shorted dystocia and the baby ended up with difficulties, lifelong disabilities very severely. So when this case came to court, what happened was that the case was presented the risks of a caesarian section electively for that lady, versus her having a normal delivery. She said that if she had been concerted by the risks of anything happening to us, did happen with her son, she would, of course, have opted for an elective caesarian section. Any tiny risk to matter how small was not going to be worth taking ...felly o'n rhoi gael y mae'r iawn. Dyma'r hwn yn ymdweithio. Yn ymgyrch yn Ymdweithio, y bydda I am ymdweithio... ...y mae'r cyflwpatiaeth wedi'u cyflwpatiaeth... ...y brosesu ar y cyflwpatiaeth... ...eg yw'r cyflwpatiaeth yn ogylcheddol. Mae'r cyflwpatiaeth ymdweithio... ...y'r cyflwpatiaeth sy'n ymdweithio... ...y fyddech chi'n gwybod iddynt yn ymddweithio. .. sy'n dysparwyr y byddwn yn hyn tyn ni'n ddweud o'r perthysgol sy'n gweithio'r dud yn hynny. Mae'r ddweud yn bwysigai. Yn yr dyfa, y methu sy'n mynd i'w cael ei sefydlu... .. nid yw'n ddiddordeb yn gweithio'r ddweud? Felly, mae'r prysgwr yn unigol yn ddiddordeb oedd y bydd ymlaen i'r cysylltu cyntaf yn ddiddordeb. Felly, rwy'n credu ymlaen i gyd yn ddiddordeb yng nghymru o'r pryd. Mae'r pretyl yn y ddiddordeb ar y pryd yn y cyd-ddiadau. So rwy'n gwneud yn llwyddu tastesa gweithio i ymddangos ein hwn anghyfnol a'r hyfrif eich holl hwn yn ddiweddar Dod o'r clyw gyda borders ond yn cyfhwytoedd ydy'r cyfnod yn eu rai yn ni ystyried na'n golygu'i yma, gallwn yn beth ymd displayedr wedi'u gwrth o'r cyfrif yma nid oherwydd eich cyflwytaeth oherwydd roi yn gwneud. o beth oedd y cysylltyniol wedi bod yn gwneud hynny ti'n gwybanddiol i chi yw'r gwbl am y cyfnodol, i gweithio cyflwyno o phobl, ac mae genny, mae'n ddweud arall o bobl i gweithio pan o'ch byddio i chi yn oed am ddweud o bobl i gydion i gydion i dweud o bobl, a'i ddweud â llawer o ffordd yn ddweud o bobl i gydion i gyllidol i gydion i Gwdydd, â'u gwbl yn edrych i goll i copeid,oli a hun i gydion i hynny o hollogau, a dyma'i ddweud o'r bysfyn. Mae hwn i'n meddwl i'n mynd i'n gweithio ar amser. Mae'n meddwl gan weithio ar ddiolch. Mae'n meddwl yn y maen nhw. Mae'n meddwl yn y maen nhw i ymgyrchu i ymgyrchu ymgyrchu, ac mae'n meddwl yn cael ei gweithio ar y maen nhw i. Maen nhw'n meddwl i'r meddwl i'r ymgyrchu. Mae ydych yn gweithio'r hwn o'r gwygon, o'r gwygon sy'n gweithio ar y gyfer. Mae'n gweithio'n gweithio ar y prysyn. Rwy'n meddwl, mae'r ffordd gwneud o'r cyffredinol ymdweud yn y ffordd gwneud i'r systyth. Mae'n ddweud i'r gweithio i'r gwygon o'r ffordd gwneud i'r ffordd gwneud i'r ffordd gwneud i'r ffordd gwneud i'r ffordd gwneud, a bobl o'r llyf, a'r rher dylai y cerddau ei bod yn dod angen mewn gweithio yn ffordd yn y rhaid. A'r rhaid hyn o'n gweithio'n gweithio'n gweithio. Mae rhan o'r ddim yn y ffasg yn ei ddweud, a'i d solvent Arnau Rhan o'r Hywodraeth II. Ac roeddwn i'r parod o'ch bod yw hefyd yw hefyd o cynnig a'r hefyd i'w hefyd sydd hynny yn ddod o'r sefydlu. Rwy'n wneud bod hefyd o'r hefyd o'r hefyd o'r hyn o'r pryn gweithio. Rwyf i chi'n gwneud y cydweithio hwn yn y model yng Nghymru yw'r hynod yn ffordd hwn yn dweud. Mae hynny oedd y mynnug o'r ff cause yng Nghymru, a'r bobl hwn yn ffordd, yw y bwysig, yw mynd i'r meddwl, yw mynd i'r mynd i'r dysgu. Eogel I'r bobl wrth hyn yn mynd i'w ymgau sy'n cymdeithasol. Mae hyn yn mynd i'w gynllun roedd yn ymgynnu'r bobl. Dwi'n credu yw'r ddau, dwi'n mwy o'r ddau ac rwy'n adael y cwmprwyntau, a'u wneud o'r adael. Dw i'r rhan o'r gwahanol i'r Llyfrgellau Ilyfrgellau, a dwi'n credu'r hystolwyr тыfnol yn y Llyfrgellau U ofs, ac yn y Cymru, felly i'r rhaglen o'r ffaptor o'r ffordd. Ysgrifennu Llyfrgellau yw Llyfrgellau Rydyn Scotland yw 32% yn y cwm hosfotoil ac 18% yn y cwm hosfotoil. I'm not prepared to blame the mothers, the babies or the wounds for those differences in practice. I'm not planning other specialties, so if we take hip fracture, the commonest fracture in number, and variabilitating, we know that the outcome is better if you have your hip fracture repaired with a hip fracture When we look at what the total time that people are in hospital after a hip fracture, that varies across Scotland from a median of 13 days in one unit to a median of 23 days in another unit. In one unit in Scotland, 63% of people get back home after their hip fracture and in another unit in Scotland, 95% of people get back home after their hip fracture. And I'm not prepared to blame the hips or the elderly people for those variations like that. When I look at urology, the rates of cystoscopy, so my are rather sent to think of a look in the bladder, the rates of cystoscopy varies across Scotland by a factor of fourfold. Again, it's not the bladder's fault. Everywhere I go, I look at these data and I ask questions. I don't know what the right rate of hysterectomy is. I don't know what the right rate of induction of labour is, but I don't talk to the orthopedic surgeons about how long people should stay in hospital. So I ask the questions and in fact people are very surprised by these differences in data, these differences in how the best units are performing in a small country compared to others. So I think we need to reduce this unwarranted variation in practice because what it needs to is unwarranted differences in how it comes. People do less well if that is not prepared in a factor of six or out of nine. So I talk also about managing risk. Managing risk, of course, in our Scottish well-needed Scottish patient safety programme has made a huge difference to hospital mortality rates, to our infection rates in hospitals. It is a big pause in the message. But for our major, major issues, I'm calling kindly, to talk about the work that I've done is reducing still birth stress, and our still birth rate is going to be static for 20 years in Scotland. Our still birth rate has fallen by 15% in the last four years since we looked at still births, the causes of still births, and decided not to accept that still births just happened because they just happened and actually did something about it. And so there were 100 families who took a baby home last year, 100 more families who took a baby home last year and have taken a baby home the year before because they've managed to prevent those 100 still births. So that's very important. But managing risk, of course, is very sophisticated. And the senior decision maker who takes the riskiest decisions is often the medical professional. Other professionals also do, but the doctor is often the one who is taking those difficult decisions. But do we realise that when people are under stress, when they're overworked, and the volume of work is greater, then it is that decision making about risk that disappears first. So people become very risk averse when they are stressed. So I wonder whether we actually support our health service colleagues or nurses, doctors, business, pharmacists, paramedics, because actually what they will become is risk averse. They will make poorer decisions, and that will affect our performance. So I also talk about becoming improved as an innovator. So I think that people think that innovators need to be inventing machine or cure for something. But in fact what I have seen is innovation everywhere I've been to. I've been to some of the wars where the most junior doctors were telling me about their quality improvement and practices. So do you think very junior doctors, one of their tasks, any of them have been junior doctors, and one of their tasks is of course to take the blood. There are affibotomists to help, but the doctor always ends up with the most difficult cases to get the blood for. So what the junior doctors realised was that there are always a lot of blood tests left over at the end of the day that the hand will be taken. Also that was that this was actually the median discharge for some of these people because the result was being expected by the consultant, the result wasn't ready, and in fact the blood having actually left the patients are. So what they did was they filmed on their iPhone, they filmed all of the steps it is from someone asking for a blood test to that blood test getting the result in the patient's note. And they realised that during that process there were eight redundant steps, either repeated or not needed at all. So they chopped out the eight redundant steps, they spoke to their phobotomy colleagues, their system, much more efficient, and they actually reduced the length of stay on that cost of the day. The most junior cost nothing, and yet most people were the right people to be changing their own system because they as a junior doctors are the ones that knew where the changes could be made. But I also talk then about bigger improvements, bigger innovations. What I ask about is whether in fact we are actually implementing the practice in medicine that we already know works well. So you'll be familiar perhaps with the need, the guidance to give people aspirin if they've had a cardiovascular event, a stroke or a heart attack, you get aspirin and that will prevent to some extent a second event. And most people are eligible to have aspirin. In Scotland, how many people who are eligible for aspirin get aspirin I wonder. Stroke might get another one, let's figure something that costs 1.50 to prevent another stroke. Pretty simple? Well only 57% of people who are eligible for aspirin actually get it. So what do we do about that problem? What we did was, we thought, I don't want less. I do a lot of work in the lab and come up with another drug that's much more effective. It's called propigodol and it is more effective. But it would need to be 90% more effective to have the same effect as giving the other 42% of people aspirin who are actually eligible for aspirin. The drug costs 10 times as much and I'm afraid it's only 10% more effective than aspirin. Well I told you my report about translating what we know in research into actual practice on the drug. And I talk about the importance of research being actually relevant to the NHS and the importance of research into treatments or medication that's actually going to be used by the NHS. Perhaps maybe moving away from research for research sake and actually moving into something where public money is being spent to improve our outcomes. So maybe we need some research into why everybody doesn't get aspirin. Not inventing another drug that's a bigger, better aspirin. So I talk about that and I've talked to academic audiences about that. They don't necessarily feel that I'm necessarily the most popular pressure in the room when I'm challenged and like that but I think it's important to ask the questions just after all this public money. So you'll see on my slide that the infographic has been shared all over the world and what people have said is we're not sure that we really like this realistic medicine it's a bit medicated. I said well I'm not having a doctor when I'm in the tube but it's also that I've moved to the doctor so that was where this came from but actually a lot of different groups would like to have their own version of realistic medicine. The pharmacist would need to be called realistic medicines and they're not supposed to suggest that it should be realistic healthcare or in fact perhaps realistic health and social care and I have no problem with that because I think what this has become is a way of talking about what I've practised in medicine. And by the last medicine or healthcare or health and social care I don't mind. So this is the majority of suffocation if you believe me and that's the value of anything. And some of you may or may not use some of your grade he is really one of the founding fathers of public health he invented screening as we know it and his comment was half and cold for it I was understated in my praise it's one of the best documents I have read in future for a year and he's a lot of young people. So where do we go? Although we do, where do we go next for a thing? So these are some of the comments that I thought the philosophical society would like to talk about. I was very pleased actually to be coming back to Rotterrow being in Rotterrow since I was a medical student in Glasgow and I was in the doctors in the authority unit, so where are they from? So is this just emotion? I told you some nice anecdotal stories when you tackle those with some job lying in stories about my own children so perhaps this is just emotional? Someone has said it's enlightened is this a new way of thinking? And our medical schools around the country have said that they will put realistic medicine on their service within the group. It seems to have a global application. My Barcelona conference has now got spread to Quebec City and an invite to Salzburg in Austria in December. Does it maybe bring back the art of medicine? A little bit more art. Look at the science. And I wonder does it play to the very well-known Scottish intellectual and philosophical wisdom and maybe that's why it's been well received as it has. What I have done though is really trying to make sure that it is joining up with the vision of the Scottish Government. May or may not have time to review the national clinical strategy for Scotland you'll find within it a chapter on realistic medicine. What I'm saying to my ministerial colleagues, to my Government policy colleagues is that I think that some of these difficult decisions will be made about healthcare and perhaps be made better if we're about to say the various aspects of realistic medicine. I'm bringing the patience of the people along with us on that journey and so far I haven't had any dissent. So I have proposed to you that perhaps this is a new hypothetical philosophy. Let's put my doctor colleagues back in their positions of leadership. It is absolutely about the multidisciplinary team. Absolutely must be. I couldn't do my job as an obstetrician without the midwives, but we did my job as an obstetrician without the healthcare workers, nor the theatre assistants, nor the passion between the theatre after this is out in the section. So I am absolutely so good on the multidisciplinary team. But the multidisciplinary team is leadership and the leadership often falls in the palms of the doctors. What are the most senior members of the team? So I wonder if we can also be creative. Certainly it's about empathy always has been. But perhaps the medics, the doctors, the healthcare professionals, whoever might maybe need more of a facilitator. More of a collaborator and they definitely need to be a communicator. They study in the 1970s in between medical students when they started. They start medical school very, very, very passion focused. And they leave it disease focused. But it is a disease as we are looking after, is it? So it is perhaps that person that person at the centre of the care that we should be talking to. So I am going to close on this was a cartoon that somebody sent to me. You may be familiar with the Scottish Interpreter Guideline Network with Simon Guideline. And Boyd Peters who is a medical director in the NHS Highland is a psychiatrist. He has written a drawing of my business manager Mark Stanley at my door of some wise gay doctor on the phone asking for the side guideline for realisticness. What has made me think? And once I suspect I can track down John Cinsella who is the chair of the signed committee and perhaps we'll put it to him that maybe we do need a guideline for realisticness. I hope it's meant something to this audience. I'm very grateful as I say for the invitation and I know we've got plenty of time for questions and answers. I leave you with my contact details. So email me, tweet, look at the blog because I hope that realistic medicine really takes off and goes somewhere. But it won't do it by support and is by feedback and comments. So thank you very much.