Selling Sickness 2013

slow medicine

Breathe in, 2, 3, 4. Hold it. Breathe out, 2, 3, 4. Generalize to the world!

Over the past 3 decades, a spreading “Slow Movement” has been challenging the prevailing social tendency to cram as many events and accomplishments into every day and every life as possible. Instead, we are encouraged to – breathe slowly – emphasize quality over quantity and mindfulness over speed as in relaxed family evenings, handmade gifts, long baths, talking on the telephone, and cooking dinners from scratch. Carl Honore (2005) has written the manifesto of this slow movement,  detailing the ways speed is ruining our lives and our planet.

It’s ironic that I (L.T.) am writing this during the winter Olympics, having stayed up late last night to watch – whoosh – downhill and mogul skiing and – superfast – half-pipe snowboarding. Do they breathe at all in those competitions?

The stopwatch and the scorecard may still be king in sports, but in medicine, there is growing respect in specialties such as oncology, geriatrics, internal medicine, and even emergency medicine for doing less, listening more and delaying high-tech intervention.

The language of “Slow Medicine” began in Italy in 2002 (N.B. the “Slow Food” movement began in reaction against a McDonald’s in the middle of Rome in 1986). Italian cardiologist Alberto Dolara recommended a “strategy” of “slow medicine” to allow time to fully evaluate the personal, familial and social problems of patients before recommending technological interventions. The approach included longer hospitalizations (i.e., slower discharge planning) and more emotional support to terminal patients and their families. A recent Ob-GYN study in this tradition recommended waiting longer to intervene in second-stage labor.

Katy Butler, who made a powerful presentation at the recent Lown conference on overtreatment, has written the wrenching story of trying to undo the hasty and unnecessary medical intervention wherein her demented father had a pacemaker inserted as part of a routine preoperative clearance for hernia surgery. Undoing the mistake turned out to be heartbreakingly difficult.

The Italian Slow medicine movement, with its blue and green snails logo has recently joined with Choosing Wisely  to develop tactics to limit overuse of medical resources in Italy. Clearly this is a movement that is global.

The benefits of slowing down decision-making and intervening fit with so much of the Selling Sickness philosophy. Take a few moments – and then take a few more – to think about it.

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