Medical professionals should ‘Slow’ down when treating aging patients

Slow Medicine

How can medical professionals help caregivers and loved ones who are overwhelmed by too many options? Amramp’s in-depth interview with Dr. Dennis McCullough, professor at Dartmouth Medical School and author of My Mother, Your Mother, may surprise you. What is “Slow Medicine”? A quick primer to avoid “death by intensive care,” where the medical treatment is more destructive than the disease itself.

What is the Best Way to Implement Slow Medicine? An Interview with Dr. McCullough

Q: Today's medical-industrial complex can make Slow Medicine a tough sell for medical professionals. How can one person make a difference for his/her patients and profession?

A: It’s true that many feel their hands are tied by the system. Even though they have good intentions and would like to do things differently, they still need to operate in the context of current limitations. One misinterpretation that physicians, for example, have is that they believe that practicing Slow Medicine simply means doubling the time that they spend with patients. Rather, it’s giving older people and their families more time to really understand the implications of the advice and suggestions.

“Compliance” has been a popular term here to describe whether or not a patient follows the medical regime and advice they’ve received, even if these patients have not had the chance to really understand it. So they go home and don’t get a prescription filled and then are labeled as “failing to comply.” It takes a while for any of us as patients to really understand and integrate new information, especially patients who are getting on in years.

One very simple thing is to succinctly share your thinking and reasoning when you’re making a case for a recommendation – to explain to the patient how you reached the conclusion. This really does make a difference.

Q: How can slow medicine be implemented by case workers, or OTs and PTs?

A: The main idea is to help older people and their families really think about the issues of aging in relation to the medical problems going on. How does the medical information and advice that patients receive relate to the context of where they are in their life? It’s going to be different on an individual-by-individual basis.

So PTs can ask things like, “Given how your life has changed now that you’re older, what kind of pace do you think would work best for you?” Be sensitive to their responses, listen to them, and try to go at the pace they feel comfortable with.

Q: Are there specific steps that medical professionals can take on their own that wouldn't require approval from health care bureaucracies?

A: Invite a patient to always bring someone else with them to appointments, a second set of ears to help the patient understand what’s being said. This could be a son, daughter, spouse, or friend. When older people ask how they can start practicing Slow Medicine, I say, “Never go to a doctor’s visit alone.”

All of us have some capacity to mishear things or omit information. Especially when you’re stressed and the adrenaline is pumping, it’s tough to gather your thoughts. Having two people there is helpful because it also helps to continue the conversation after leaving the doctor’s office. It encourages the process of reflection: “What did he say? What am I thinking and feeling about that?”

Q: How can medical professionals institute Slow Medicine approaches with their colleagues?

A: Very simply, in discussions with colleagues, be sure to include information about how an older person is functioning: Are they frail? Should their state be affecting how we think about them?

Overuse of medications is a huge problem, and doctors feel that the medications they’re prescribing are more important than the meds that another doctor recommends. How can we help older people to get along with fewer medications? Try doing trials and looking at the pros and cons of medications much more carefully. Primary care physicians are supposed to be the negotiators, but the patient and their friends and families need to be the negotiators as well.

Often, we’re not aware of demands on an older person. A prescription blood thinning medication that requires frequent blood tests to be drawn might be a huge time and energy burden on a patient and her family; whereas aspirin might provide a less potent but less stressful solution and give them “more of their life” back. The most efficient solution is not necessarily the best.

Be sure to look for our September issue: Dr. McCullough answers "How can patients advocate for Slow Medicine?" and other helpful tips...