`Slow Medicine' Means Collaboration

The end of life needn't be treated as an emergency, according to proponents of "slow medicine." They say doctors and nurses who take the time to listen to and level with elderly patients and their families can make the process easier on all.

By Nancy Crotti, Star Tribune Sales and Marketing

March 25, 2009 at 8:35PM

Dennis McCullough wants elderly patients, their families and the medical professionals who care for them to stop, listen and thoughtfully plan for the one outcome every patient will have: death.

A physician and author of "My Mother, Your Mother: Embracing `Slow Medicine,' the Compassionate Approach to Caring for Your Aging Loved Ones" (HarperCollins), McCullough believes that the cascade of medical interventions that usually follow rushing some elderly patients to the emergency room can cause more suffering than good. A geriatrician at Dartmouth College, McCullough espouses establishing a relationship in which doctors, nurse practitioners, patients and families talk in a non-hurried way about their end-of-life preferences.

Taking time to listen, share perspectives

"It expands the concept of an advanced directive," explains Robert Kane, M.D., who directs the Center on Aging and the Minnesota Geriatric Education Center at the University of Minnesota. "This involves a much more gradual conversation that goes on over time, that is slow enough to be able to involve the family and to surface differences of opinion."

The bias in this approach is to do less rather than more, according to Kane. That has led some to criticize it as being unfeeling and doctor-centric. Stanley Smith, M.D., a geriatrician with Stillwater Medical Group, disagrees.

"It is sad that some people think that I am trying to write old people off when I am trying to follow the person's wishes for end-of-life care," Smith says. "I'm trying to be compassionate and contemplative about their care."

Not one-size-fits-all

To better provide appropriate and humane care for residents near the end of life, Smith explains, "No simple algorithm can choose the optimal medical therapy for this population. What is required is an individualized risk-benefit analysis that attempts to honor the patient's and caregiver's unique situation for each intervention. This requires a healthcare provider with extensive knowledge and time to discuss these issues."

Elderly patients and families who are unprepared or uninformed often act strictly from emotions and can enter a painful and costly medical spiral when a health challenge arises, according to proponents of slow medicine.

"Medicine is so fast-paced, you get to the ER and the doctor just starts doing things," Smith explains. "They do tests and they do labs before they ever stop to ask, `Well, who is this person?' Once that ball starts rolling, it's really hard to stop it."

The effects of such treatment may be more negative than positive for older patients, especially if they suffer from such diseases as acute leukemia, congestive heart failure and pancreatic cancer, according to Kane. "A lot of people see slow medicine as a step in the right direction," he says. "It gets people talking and that is a critical step."

about the writer

about the writer

Nancy Crotti, Star Tribune Sales and Marketing