NEW BLOG: ‘Slow Medicine’ helps us pause and return to basics
It was a happy convergence that brought us together, two primary care physicians who share a philosophy of care we’ve come to call “Slow Medicine.”
We met in 2006 at the Cambridge Health Alliance — a leading safety-net health system in Massachusetts — where Pieter was an attending physician and Michael a resident trainee. We both were struck by the tendency in our current health care system to “do more” — more tests, more procedures, more medications, and more services — even when the evidence does not indicate that more is clearly better. We started talking informally about our shared perspectives. After Michael moved to California in 2009, the discussions continued by email and phone.
Slow Medicine: A philosophy for clinical care
Initially our exchanges were little more than brief dialogues about our shared concerns. But soon they became more solution-focused. We also increasingly looked to evidence to inform our thoughts and concerns. For example, when we became skeptical about the value of screening mammography, we dug into the evidence so that we could effectively articulate our perspective to our colleagues. We ended up supporting new recommendations that women receive mammograms every two years starting at age 50 rather than annually beginning at 40.
We also became fascinated by the Dartmouth Atlas of Health Care, which revealed dramatic variations in how medicine was practiced throughout the U.S. Most notably, regions with more intense care did not necessarily have better patient outcomes. We also became ardent followers of the “Less is More” series in the medical journal JAMA Internal Medicine, as well as disciples of Gordie Schiff’s principles of conservative clinical practice — both of which shaped our thinking in important ways.
Eventually, we coined the term “Slow Medicine” to describe our overarching philosophy of clinical care. We didn’t realize it then, but many others have been using the term "slow medicine" for several years to describe remarkably similar principles of clinical care. Our version of Slow Medicine refers to a thoughtful, evidence-based approach to care, emphasizing careful clinical reasoning. It draws on many of the principles of the broader “Slow Movement,” which have been applied to a wide range of fields, including food, art, parenting and technology.
More isn’t necessarily better
Like the broader Slow Movement, which emphasizes careful reflection, our version of Slow Medicine emphasizes careful interviewing, examination and observation of the patient. It reminds us that the purpose of health care is to improve the well being of patients, not simply to utilize the ever-growing array of costly medical tools and gadgets. While we are eager to promote innovation, we believe clinical advances need to be adopted and implemented in a methodical manner and only after it's clear that newer really is better.
A few years ago, Pieter began broadening our email discussions to his medical trainees at the Cambridge Health Alliance and Harvard Medical School, where he teaches. Michael began helping Pieter with these increasingly regular email dispatches. The posts are typically brief — 200 to 600 words — and provide our take on timely clinical topics through the “Slow Medicine” lens. We tackle the latest literature and often generate lively discussion, dissension and new ideas from our ever-growing readership. We now call these missives “Updates in Slow Medicine.”
For example, in recent posts we’ve raised concerns about overly exuberant use of medications to assist with smoking cessation, new complicated recommendations from the Centers for Disease Control advocating for the use of an expensive and unproven pneumonia vaccine, and new models of concierge primary care.
Through word of mouth, our list has grown. In December 2014, our discussion group expanded considerably when one of our former teachers, now the interim president of the University of Oklahoma-Tulsa, wrote a blog on NPR that placed our work in the broader Slow Medicine context. Today, our Updates are sent to hundreds of clinicians. Still, we’ve maintained our informal approach, addressing readers as “Dear Housestaff” and writing as if everyone on the list will be joining us in clinic later in the afternoon.
We’re now excited to begin distributing some of our posts even more widely through Reporting on Health. We look forward to your feedback, and if you are interested in signing up for our regular email postings let us know!
"Updates in Slow Medicine" applies the latest medical research to support a thoughtful approach to clinical care. To learn more, visit our Facebook page. To receive all of our updates, contact Drs. Michael Hochman and Pieter Cohen at pcohen@challiance.org.
Photo via takomabibelot via Flickr.