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Slow Food, Meet Slow Medicine21:59Download

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The slow food movement was born almost 30 years ago in Italy — mostly as a protest to the opening of that country's first McDonald's. It has grown into a movement that values cooking, nutrition, and quality. A focus on the mindful, and an avoidance of industrialized processed foods.

A similar approach to medical care is catching on right here in Boston. It's called "Slow Medicine." Slow medicine means really getting to know your patients instead of just treating them. And it means valuing slow observation instead of quick intervention.

Guest

Dr. Pieter Cohen, a primary care doctor at Cambridge Health Alliance.

The Doctor Is In: Questions About 'Slow Medicine'

What does slow food have to do with slow medicine?

Pieter Cohen: “I’d like to think that we borrow three main principles from the slow food movement. One is to really get to know, in the case of food, your food. If you’re not growing it yourself, get to know your butchers, the farmer, your baker. Similarly, of course, it’s getting to know your patient…. The second major theme is that the latest fad or the latest gizmo is not necessarily the best approach.... And third is to appreciate slowing down.”

Doesn’t a doctor have to move quickly to see all her patients?

PC: “Personally, in clinic, I need to move quite fast...I only have 20 minutes per patient…. So, the slowing down has to do with slowly integrating the advances in medical care in what we do. And it also means slowing down and not rushing diagnostic testing or studies or treatment. So if I see a patient and we’re not sure what’s going on, we would first ask ourselves why not see them back in a week or two? Why not let time declare the diagnosis?… Even the best clinician cannot, within a minute or two, make a sophisticated diagnosis.”

PC: “We’re not reinventing the practice of medicine, we’re simply getting back to the roots of medical practice. Spending our time carefully discussing the story, the interview with the patient, carefully examining the patient, and letting that guide all future decisions. In addition, of course, the patient’s individual values and interests in pursuing their problem.”

Does slow medicine have to include multiple visits to the doctor?

PC: “The idea is that so many patients come to us with concerns that the biggest harm is unnecessarily intervening, unnecessarily treating. If we can spend time talking to the patient, examining them meticulously, then letting them know that we are not worried right now about serious illness but we’re going to follow with you. We care about you and we want to know if symptoms change. It has to be combined with caring and follow-up. Because if you’re in a situation where you can’t see someone in the future, you can’t guarantee follow-up care and you don’t express personal interest in the patient, you’re not going to make much progress in reassuring them.”

What if I’m busy and can’t come back for another visit?

PC: “We need to have different approaches than just coming and being seen again in clinic in a week. So two options with [the example of] the sinus infection. One is delayed prescription. So once patients understand that taking antibiotics now is unnecessary, you can often...give a prescription now and if you’re still ill or symptoms worsen, then...pick up the prescription. If not, don’t. And another possibility is to check in over the phone. And of course we often work in teams, so it might not be myself, but it might be our nurse on the team who’s calling to check in a week later. And if symptoms persist at that time, prescribing antibiotics.”

What about acting fast when intervening in medical emergencies?

PC: “We absolutely are not advocating for just simply not intervening or just sitting around and doing nothing. We’re actually talking about using the best evidence available. So a perfect example of this comes up with stroke treatment. Just this week there’s new data to suggest that if someone has a stroke or a clot gets up to the brain, that there is new technology that can reach in a pull out that clot, that for the first time we’re seeing evidence that that can work in addition to giving very powerful blood thinners. This is a great example where, though we mention slow medicine, we sometimes are very fast adapters once the evidence becomes clear that that will improve outcomes.”

How can I avoid unnecessary screening?

PC: “Let’s think about screening…. What screening means is that we take a person who is completely healthy. They came to you because they’re great and they just want to live longer and healthier. And then we are intervening as physicians and we’re saying do this study or this study and you’ll live longer, presumably, or healthier. So the bar should be pretty high to suggest something to a healthy person in order to try to improve their health. And in the case of breast cancer, that’s a great example. Let’s look at mammography screening for women in their 40s. So it does decrease a woman’s risk of dying from breast cancer. But it does so with one woman out of a thousand screened. The problem is that the majority of women who are screened get unnecessary treatments. About half of the women screened over a ten year period will have unnecessary false alarms. These might lead to biopsies, and sometimes even diagnoses of cancer that never need to be treated in the first place.”

How do you teach slow medicine to new doctors?

PC: “A dean of Harvard Medical School in the 1940s,Sidney Burwell, famously said… to the fourth years, ‘You’re graduating now, but the problem is 50% of what we’ve taught you is wrong. But what’s even more concerning than that--I don’t even know which 50% it is.’ So my students tell me that the slow medicine approach is like trying every day to try to figure out what is that 50% that we got wrong, and getting it right tomorrow.”

More

WBUR's CommonHealth: You've Heard Of The 'Slow Food' Movement? Now Meet 'Slow Medicine'

  • "'Slow Medicine' may be about to catch on fast. It began as thousands of emails over the years between Cambridge Health Alliance primary care doctor Pieter Cohen and Dr. Michael Hochman of Altamed Health in Los Angeles, debating and interpreting the latest medical literature. First just back-and-forths with each other, then shared more broadly with colleagues."

NPR: If Slow Is Good For Food, Why Not Medicine?

  • "Slow medicine adherents will be quick to tell you that the vast majority of CT scans ordered in emergency departments are of little value, most of the time adding only unnecessary cost and radiation risks for patients. Antibiotics for colds are another example of harmful waste. They don't work for viruses, and patients who take antibiotics are more likely to develop resistant bacteria, diarrhea and other symptoms that lead to avoidable office visits and hospitalizations."

This segment aired on December 18, 2014.

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