Slow Medicine

The slow medicine movement is to medical care what the slow food movement is to fast food. Slow medicine is about taking time to examine or re-examine a patient, to consult other health care practitioners, to study test results carefully, or to discontinue medications if they’re not required. Sometimes it involves doing nothing.

Overtreatment

Slowing down the fast decision-making process that’s become synonymous with modern medical care gives doctors time to listen to patients. Slow medicine allows physicians to contemplate whether a procedure or test is necessary and/or justified. In the case of elderly or terminally ill patients, it’s about whether treatment enhances quality of life.

A 2009 survey of American primary care physicians revealed that

• 42 percent felt their patients were receiving too much care
• 76 percent said they overtreated patients due to concerns about malpractice suits
• 62 percent felt diagnostic tests were utilized aggressively because they create income for medical subspecialists
• 40 percent said they didn’t have enough time to spend with their patients

Despite differences in our health care systems, similar opinions exist in Canada. A 2011 review found that, in Canada, physicians order inappropriate tests due to increasing workloads and patient pressure. Best practice standards for diagnostic imaging are rapidly changing, and Canadian doctors’ fear of liability and malpractice means they order more tests than necessary.

Diagnostic medical testing can be critical to a proper diagnosis, but it can lead to increased health care costs while not always benefiting patients. The Canadian Association of Radiologists stated in 2009 that up to 30 percent of CT scans and other imaging methods are “inappropriate or contribute no useful information.”

According to a 2013 discussion paper released by the Québec Medical Association, “overdiagnosis, overtreatment, gaps in healthcare coordination, hospital-acquired infections, medication errors, preventable incidents, and readmissions at every level of the healthcare system” contributed to an estimated $5 billion in inefficient health care spending in Québec.

Despite this trend in overtreatment, busy physicians may have only 10 to 15 minutes to spend with a patient per visit, and diagnosing a problem may take 10 to 12 minutes. A 2014 study found that doctors who use computers to access patients’ electronic health records during an appointment spend one-third of the visit looking at the computer screen.

Patient-centred care

The slow medicine movement presents an alternative to the growing problem of high-cost, technology-driven, depersonalized patient care. Dr. Alberto Dolara, an Italian cardiologist, wrote the first journal article on slow medicine in 2002, advocating its use in many medical situations, including palliative care. Dennis McCullough, an American family doctor and geriatrician, promoted slow medicine for geriatric patients in his book My Mother, Your Mother (HarperCollins, 2009).

More than 500 doctors and health care practitioners have signed an online declaration of the Right Care Alliance (rightcaredeclaration.org), a movement which embraces many slow medicine principles, including

• patients should be safe from unnecessary treatment and needless harm
• patients should feel cared for as whole persons
• patients should be informed and involved in choices about their treatment
• clinicians should have the time they need to care for their patients
• clinicians should make clinical judgments in the best interests of their patients
• clinicians have the ethical obligation to always put patients’ needs first

Familiar concepts

If these “new” medical principles sound familiar, it’s because they’re at the heart of many complementary and alternative medicine (CAM) modalities. CAM could be said to be the original “slow” medicine.

What these philosophies share is a focus on holistic health care: treating the whole person, not just symptoms. Mind, body, spirit, and community are important factors as practitioner and patient work together to maintain health, and prevent and heal disease.

We asked four of alive’s editorial advisory board members to help us compare four CAM modalities. Their principles are similar to those advocated by slow medicine proponents.

Traditional Chinese medicine (TCM)

Melissa Carr, DrTCM, is also a registered acupuncturist and a registered TCM herbalist. She offers us insight into the philosophy behind TCM.

Philosophy of disease

“TCM looks at symptoms and disease as issues of imbalance, a way for the body to communicate that something needs to be addressed. We treat both the root (cause) and branch (symptom) of a disease. Treating the root is what you might call “slow” medicine because it takes some time to dig down,” Carr says.

“We need to treat the root, otherwise the issue will just keep returning. Treating the branch is what you might call “fast” medicine because we have ways to treat just the symptoms. But simply suppressing a symptom doesn’t necessarily change the pattern of illness.”

Philosophy of patient care

TCM considers the whole person. Carr says that when someone asks her if she treats Crohn’s or migraines or diabetes, she responds that she’s treating the patient. TCM may treat one person’s migraines with quite a different protocol than it uses to treat another person’s migraines.

Role of the patient

“I consider one of the most important pieces of what I do is to educate my patients about health,” says Carr. “While TCM is a complex system that takes years of study to understand in a deep fashion, many of the principles and practices are actually quite simple and can be applied by patients. TCM is a system to optimize wellness, not just treat disease. It educates [patients] about daily healthy living choices for food, sleep, exercise, activities, and more.”

Doctor-patient relationship

The relationship between the TCM doctor and the patient should be a cooperative one. Carr says, “I encourage my patients to ask questions, because the more the patient understands about the process and the meaning and feeling of wellness, the better the results.”

Homeopathy

Nicole Duelli is a certified classical homeopath with a background in naturopathic medicine. She’s specialized in the health of women, children, and families since 1995.

Philosophy of disease

Like TCM, Duelli says, “In homeopathy, disease and its symptoms are always expressions of an internal imbalance. The symptoms are viewed as expressions of the body working to rebalance itself. For instance, if you have a fever, it’s because your immune system is fighting a germ. So the problem is not the fever; the problem is the weakened immune system which allowed the germ in the first place.”

In classical homeopathy, the ultimate goal is better long-term health, increased vitality, and improved resilience. The goal is less, rather than more, treatment over time.

Philosophy of patient care

Homeopathy treats the whole person rather than the superficial health problem. Duelli says, “Its guiding principle is “like heals like.” In treating the whole person, a remedy is chosen according to the Law of Similars, that is, according to its similarity to symptoms a healthy person experiences from repeatedly being exposed to the substance.

“Homeopathic medicines are uniquely prepared. Made from natural substances, such as herbs, minerals, and venoms, these substances are specially prepared, diluted, and succussed, then typically administered in pill form. The preparation enables the unique medicines to have none of the toxic effects of the original substances and yet have a stronger effect in stimulating the body’s healing processes than the original substance.

“Safe for children, pregnant women, and the elderly when administered without careless repetition, homeopathic medicines do not interact with medications, making it possibly the perfect complementary medicine,” she says.

Role of the patient

The patient must be aware of his or her body and its symptoms. If a person is injured, for example, a remedy may help with inflammation and facilitate healing, but the person has a responsibility to rest. Diet and lifestyle may be other contributing factors to disease and are considered on an individual patient basis.

Homeopath-patient relationship

“Each person is treated individually, and this takes time, so homeopaths get to know their patients well and patients benefit from this valuable one-on-one time spent on their health,” says Duelli.

She cautions that homeopaths never replace good conventional health care, for instance checkups, diagnosis, or emergency care, but they provide the perfect complement to facilitate healing, such as when conventional care is unable to address a chronic problem easily.

Naturopathic medicine

Elvis Ali, ND, is a board member of the Ontario Association of Naturopathic Doctors, an author, and an international lecturer.

Philosophy of disease

Naturopathic medicine treats disease by identifying and removing the underlying cause of illness, rather than suppressing the symptoms. By stimulating the healing power of the body, these underlying causes can be treated. Ali says, “Symptoms of disease are seen as warning signals of improper functioning of the body and unfavourable lifestyle habits. Naturopathic medicine emphasizes disease as a process rather than as an entity.”

Philosophy of patient care

Like TCM and homeopathy, naturopathic medicine seeks to heal the whole person through individualized treatment. It seeks to understand “the unique physical, mental, emotional, genetic, environmental, and social factors that contribute to illness and customize treatment protocols to the patient,” says Ali. To treat both acute and chronic conditions, naturopathic treatments are tailored to the individual patient’s needs.

Role of the patient

The naturopath strives to teach the patient the principles of healthy living and preventive medicine. By sharing their knowledge with the patient, naturopaths encourage each person to take responsibility for his or her own health.

Naturopathic doctor-patient relationship

The naturopath emphasizes prevention by partnering with each patient to assess the risk factors and recommend appropriate naturopathic interventions to maintain health and prevent illness.

Holistic nutrition

Allison Tannis is a registered holistic nutritionist, author, and consultant who believes that “nutrition can be easy to swallow.”

Philosophy of disease

“A healthy diet and lifestyle has been scientifically proven to promote wellness and prevent disease. However, disease does occur. When the body is suffering from a disease it is important to help the body try to heal itself by fuelling it with helpful nutrients. Nutrients can support the body to heal itself,” says Tannis.

Philosophy of patient care

A holistic nutritionist recognizes that each person is unique. “Holistic nutritionists work with clients to identify and help correct nutritional causes of disease by offering information on healthy diet, supplement, and lifestyle changes. They recognize, and teach clients, that health is affected by many factors including nutrition, stress, physical activity, and our environment,” says Tannis.

Role of the patient

Clients are educated about how their body works, how food affects the body, and how to use that information in their everyday life to prevent disease. Tannis arms her clients with information they can use in their everyday lives.

Nutritionist-client relationship

The holistic nutritionist creates an open and supportive environment. He or she can help the client discover new ways to be healthy by offering new recipes, providing leisure activity contacts, and making reading suggestions.

The growing acceptance of slow medicine attests to the fact that the principles of CAM modalities can greatly enhance the physician-patient experience in conventional Western medicine.