Slow Medicine

In a world of fast food, overpacked schedules, and nearly constant digital connection, some doctors are calling for a change in the speed of our lives — and in the medicine that is supposed to keep us healthy.

To those who embrace slow medicine, our modern lifestyle has made us sick and disconnected us from everything that matters most. And somewhere along the way, our healthcare system has become stuck in the same fast lane mentality.

In spite of the medical progress made over the past 50 years, slow medicine physicians feel that many doctors and medical schools have lost sight of what it means to heal.

Slow Medicine

Proponents of slow medicine say fighting disease now overshadows encouraging overall wellness. Invasive procedures and costly medications have taken the place of letting the body heal itself. And doctors no longer have time to listen — really listen — to their patients before rushing on to the next illness.

Just as the slow food movement tries to counter the negative effects of the fast food that surrounds us, slow medicine is aimed directly at the hectic pace of our healthcare system. But its ultimate reach is much broader.

“I see slow medicine as a treatment for the fast world and how it affects us,” said Dr. Michael Finkelstein, an internal medicine and integrative holistic medicine physician and author of “Slow Medicine: Hope and Healing for Chronic Illness.”

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Too Much Medical Treatment Can Be Harmful

Although the term “slow medicine” stirs up images of a small-town doctor’s office, this approach to healthcare is much more than just a leisurely pace in the clinic.

One common theme that runs through all the variations of slow medicine is mindfulness. This fits nicely with the broader slow movement, which promotes a more thoughtful approach to eating, food production, parenting, and technology.

With slow medicine, mindfulness comes across as doctors taking more time to talk to and examine a patient as well as consult with other doctors, re-review lab test results, and carefully consider medications and treatments. All with the goal of choosing only the care that is needed.

“For us, a lot of it has been driven by our realization as practicing clinicians that more is not always better,” said Dr. Michael Hochman, medical director for innovation at Altamed Health Services and a primary care internist in Southern California.

He and his colleague, Dr. Pieter Cohen, share their thoughts about slow medicine on the blog Reporting on Health.

For us, a lot of it has been driven by our realization as practicing clinicians that more is not always better.
Dr. Michael Hochman, Altamed Health Services

The dangers of unnecessary — and potentially harmful — medical care were highlighted by Dr. Atul Gawande, a surgeon and public health researcher, in a recent article in The New Yorker magazine called “Overkill.”

“I think that’s something we’ve been struck by as primary care clinicians,” said Hochman, referring to The New Yorker article, “how often we see our patients given tests and invasive procedures that may be appropriate in some circumstances but often lead to just as much harm as they do benefit.”

Like others in the slow medicine field, Hochman and Cohen encourage patients to try alternative treatments alongside, or in place of, medical procedures and drugs — things like diet, exercise, yoga, and meditation. But Hochman is quick to point out that even standard medical treatments have a place in slow medicine’s toolbox.

“We’re not rejecting invasive treatments and traditional Western therapies outright,” said Hochman. “We just think that we go to them too quickly and don’t think about the slower, more conservative approaches as much.”

The challenge, as they see it, is striking the right balance between traditional and alternative treatments. For that, they let the best available medical evidence guide them.

“We try to comb the literature and find out when it is appropriate to use a slower approach,” said Hochman. “Or when our slower strategies are not appropriate.”

Sometimes a slower approach is not the best option — as they argued in the case of bariatric surgery for patients with extreme obesity. But even the choice of slow or fast medicine, said Hochman, “should be a slow, mindful, thoughtful decision.”

Slow Medicine Shows Less Can Be More

The “less is more” approach to slow medicine is one that is also embraced by Dr. Dennis McCullough, a family physician and geriatrician at Dartmouth Medical School and author of “My Mother, Your Mother,” a book about caring for aging loved ones.

According to McCullough, older people can experience bad side effects from many medical procedures and medications, even the same treatments that would be considered appropriate for younger people.

On his blog and in his book, he encourages doctors and caregivers to take more time when making treatment decisions for older people. He feels this will become even more important as the population ages.

Finkelstein agrees: “When people are older, it’s time to slow it down a little bit — in terms of the rapid, knee-jerk responses that physicians often have when people are extremely ill — to really consider what’s appropriate at the end stage of life,” he said.

When a doctor rushes from patient to patient, it’s easy to focus on the illness, seeing someone only as a collection of signs and symptoms. Slowing down the process allows patients to take part in making decisions about their health. It also strengthens the relationships between doctors and patients. Ultimately, it benefits both.

“Shared decision making and thoughtful consideration of the options does require taking more time with your patients. But in the end it is much more efficient for the healthcare system as a whole,” said Hochman. “I think it’s more rewarding. I find practicing medicine in this way is much more fun for me as a doctor.”

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New Roles for Doctors in Slow Medicine

Slow medicine also encourages doctors to take on new roles in the healthcare system, moving beyond always fixing what is broken. Dr. Victoria Sweet, who writes about slow medicine in the book “God’s Hotel,” compares this new approach to that of a gardener.

“Sometimes it is better to treat a sick patient the way a gardener nurtures an ailing plant than the way a mechanic fixes a broken machine,” Sweet wrote in an essay in The Wall Street Journal.

However, each analogy — gardener and mechanic — has a place in modern medicine, even the slow kind.

“I think [doctors] have great tools for when something severe happens to us,” said Finkelstein. “An accident, a major disease? I would go to a hospital without a second thought.”

Longer-term chronic diseases, though, require a gardener’s touch, looking not for what is broken but for what is working. This is especially true for conditions like heart disease, diabetes, and obesity, which are so common in the Western world.

Sometimes it is better to treat a sick patient the way a gardener nurtures an ailing plant than the way a mechanic fixes a broken machine.
Dr. Victoria Sweet, author of “God’s Hotel”

Slow medicine can help people return their bodies — and at the same time their minds and lives — to a state of balance. Ideally, this happens before a disease progresses so far that invasive medicine and prescription drugs are the only options.

Part of this is helping people make better choices for themselves.

“So much of chronic disease in our culture is driven by obesity and other lifestyle factors,” said Hochman. “We’ve realized that the value of educating patients is as high-value or in many cases much higher-value than some of the really expensive treatments for obesity and other lifestyle problems.”

According to slow medicine, it’s never too early to start thinking about balance. Healing can begin before the first symptoms of illness appear.

“My approach is a little broader in its application,” said Finkelstein, “which means it’s not only for people who are old and not even only for people who are sick. It’s for all of us.”

Slow Medicine Embraces Broader Health

Supporters of the slow food movement see food as more than what is on the plate. The fresh vegetables, whole grains, and beans that we are encouraged to eat every day are part of a vast network of relationships — between people, their food, and the ecosystems that support them both.

In the same way, Finkelstein looks at medicine as more than the sum of its drugs and procedures.

“We need to recognize — because all of us have an interest in health — that to be as healthy as possible requires identifying all those things that contribute to how we feel,” he said.

This means thinking about everything that improves the quality of your life and the function of your body at the same time — the link between your body and mind, your relationships to other people, your connection to the environment and the divine, and your life purpose.

We have to recognize that there are a lot of dots that need to be connected, including our mind, body, spirit, and the world around us.
Dr. Michael Finkelstein, author of “Slow Medicine: Hope and Healing for Chronic Illness”

“In the end, it’s really about how we, as an individual, could be at our best,” said Finkelstein. “We have to recognize that there are a lot of dots that need to be connected, including our mind, body, spirit, and the world around us.”

In this type of slow medicine, “being sick” takes on a whole new meaning. On one hand, you have a cancer patient who still connects with others and finds meaning in life. On the other, a young marathon runner who is isolated from friends and family.

“Who’s healthier?” said Finkelstein. “Both of those people need the same approach — get back in touch with what’s really meaningful and get back in balance.”

How this happens depends upon the person and illness. For some, it might be traditional medical treatments. For others, it might mean dealing with emotional wounds or reconnecting with the cycles of nature.

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Roadblocks on Path to Slow Medicine

Doctors who tout the benefits of slow medicine are small in number, but they are slowly making headway in the medical community. Hochman and Cohen regularly write articles aimed at other physicians. For the most part, their views have been well-received.

“A lot of people have been very open and receptive to the message that maybe we are not thinking about slow medicine approaches as early and as often,” said Hochman.

But the financial incentives in the healthcare system are stacked against slow medicine. As Gawande highlighted in The New Yorker, many of the unnecessary medical procedures are also the most lucrative.

Hochman agrees.

“We probably have too many hospital beds, too many MRI machines, too many transplant centers in this country,” he said. “There’s a lot of money invested in those things. If we start taking a more slow approach across the board, there are going to be people who lose a lot of money.”

Another roadblock to slowing down medicine is that doctors are also not always encouraged to spend more time with patients. This could be a function of how they are paid for providing care, but Finkelstein argues that slow medicine can still make progress even in the face of financial challenges.

“We don’t need health insurance coverage for this,” he said. “We need an educational system. We need cultural change. We need a shift in how communities operate, so that people are encouraged to be healthy because that’s the norm.”

This will require new — slower — training for doctors. Medical schools don’t teach the kinds of “treatments” that Finkelstein uses with his own patients. Helping people repair their relationships. Talking to them about the food they eat. Encouraging them to spend time in nature or to reconnect with their spiritual side.

All of these are aimed at helping people recreate balance in their lives. Not just fixing what’s broken. As interest in slow medicine grows, Finkelstein hopes that more people will become healthier, not just in their bodies, but in their whole lives.

“Those are the things that are a form of medicine, but we’ve pushed them aside in the wake of all this technology that’s evolved over the last 50 years,” said Finkelstein. “I want to give power back to people. You have the medicine. You have the power that can be healing.”