Dr. Jeff Kane: Slow medicine
I’m afraid today’s medical pace has been influenced by that of fast food. Though we might have to wait weeks for an appointment, once we’re there things move quickly: the 10-minute visit, the rushed doctor, the unanswered questions. We can get the feeling that we’re a standardized widget on a relentless assembly line.
A more leisurely tempo is available, though. The term “Slow Medicine” first appeared in a Western medical journal only 25 years ago. Italian cardiologist Alberto Dolara recommended taking time in order to acquire a more meaningful history and to offer emotional support to patients and their families. All else equal, a longer contact is a deeper, more contemplative one. Dr. Solara noted that it results in fewer medications and procedures, and lower cost
Slow Medicine has gained traction in America mainly in hospice circles. That makes sense, since when we recognize a patient is dying, the need for speed drops away in favor of basic comfort care which — unlike curative procedures — moves at a more graceful pace.
Slow Medicine isn’t yet as popular upstream, where patients are sick but not dying. Here standard healthcare remains hurried … and frankly, that’s sometimes necessary. When your patient’s bleeding to death, you don’t ask them whether their career is fulfilling; you stop the hemorrhage. Our problem is, though, that almost all our healthcare zips down the fast lane.
For us docs, the race began in medical training’s notorious blur of hurry: draw that blood, do that spinal tap, work up those other three patients, stat. “Stat” — immediately — is one of the medical lexicon’s most familiar words.
We have a love-hate relationship with fast medicine. We want a treatment that ends our symptoms and we want it now. But most of us also resent the speed that abbreviates contact, relatively ignoring our unique personhood — our immediate presence, our attitudes, preferences and resources.
We’re not about to shift medicine into a lower gear soon, since its economics engine is built for speed. Most docs are employees these days, subject to the demands of profit-intent business, where time is money. For many reasons, the overhead in practice is greater than ever, thus the pressure to move more paying units through. Forty years ago I worked in a clinic that subtly but sternly “suggested” that I see four patients an hour. I tried it. At the end of a day I couldn’t remember any of the 20-plus faces. I left after two weeks. Today a 15-minute visit seems luxurious.
As an employed doc, I’d have to recognize that if I were to slow down from seeing 20 patients a day to eight or 10, I’d shrink my income accordingly. And face it: I have two kids in college at $40K a year in addition to still paying off my own school loans. I don’t want to believe I make medical decisions based on my financial needs, but if I’m honest with myself I’ll admit I see too many patients too quickly. So even though I don’t like the pace, I find myself ordering tests and procedures and writing prescriptions rather than simply taking time to hear a fuller truth.
It’s no coincidence that the Slow Medicine movement began in Italy, the land of unhurried sips of vino rosso and the afternoon nap. No siesta here. America remains a capital of workaholism, much of it fueled by accelerators like caffeine. When I ask a friend how he is and he replies, “Keeping busy,” I know I’m home. Our healthcare won’t benefit from slower — that is, more personal—contact until our national tempo slows. And that begins when individuals deliberately slow their own pace and demand the same of healthcare practitioners.
Jeff Kane is a physician and writer in Nevada City.
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