August 21, 2008
Slow Medicine
Slow Medicine. The term was coined by Dr. Dennis McCullough, a Dartmouth geriatrician and author of My Mother, Your Mother: Embracing Slow Medicine, the Compassionate Approach to Caring for Your Aging Loved One. In the book, which recounts his own experience with his mother's decline and eventual death, McCullough sets off the hustle and bustle of our current medical culture, particularly emergency medicine, against the singular benefits of making informed, un-rushed, ultimately wise, medical decisions through the inevitable process of aging and dying. Shifting the end-of-life care paradigm, he asserts, can spare us much undue practical, emotional and physical suffering.
One thing that may determine our society's perceptions of what should be done as regards health care for the elderly is simply what our health insurance tells us can be done - or paid for, in any case. A recent article in The New York Times noted that the "costliest patients the elderly with chronic illnesses - are the only group with universal health coverage under Medicare, leading to huge federal expenditures that experts agree are unsustainable as boomers age." According to the article, the largest expenditures are spent at "certain academic medical centers, which offer the most advanced tests, the newest remedies, the most renowned specialists" for this chronically ill population, with something like $100,000 spent over the last two years of an individual's life. We live in an age of medical technical advancements that rightly fill us with hope and wonder, but, as with all such marvelous things, we must use them wisely.
In the Spring issue of Dartmouth Medicine McCullough writes that slow medicine "is not a plan for getting ready to die. It is a plan for caring, and for living well, in the time that an elder has left." Slow medicine, which engages the support of families, friends and neighbors, as well as more specialized skills of various care providers, shifts the focus of elders' daily life away from highly "medicalized" health care. In this socially rich network, emphasis centers on appropriate physical exercise, intellectual stimulation, and emotional support. Nutritional deficiencies are addressed. Any activities of daily life that have become difficult are supported with appropriate flexible therapies. Although such support may be a very important part of the elder’s life, it need not become the focus of daily life.
The goals of slow medicine are not those that we have become accustomed to with short-term, acute, heroic medical intervention. By treating an elder’s extended support system both as directly affected by his or her aging and also as a vital element in making that process as graceful and health-filled as possible, slow medicine proposes a process that is unhurried, non-intrusive and, perhaps most important, returns the often attenuated decision-making process about end-of-life care more fully to individuals and their extended families.
Denise Barnes, The Freshwater Group
For the Elderly, Being Heard About Life’s End, Jane Gross, New York Times:
http://www.nytimes.com/2008/05/05/health/05slow.html
Slow Medicine, Dennis McCullough, M.D. in Dartmouth Medicine (Spring 2008):
http://dartmed.dartmouth.edu/spring08/html/grand_rounds.php
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