The Slow Medicine Movement: My Mother, Your Mother

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You've probably heard of the slow food movement. Well, there are some in healthcare who are calling for "slow medicine." I've seen the term over the years, but never really paid much attention, until I saw an old blog post by Kent Bottles, MD on the Healthcare Blog. Here's how Kent introduces the topic of Slow Medicine in his post:

"Slow medicine is practiced by a small, but growing subculture whose pioneer and spokesperson is Dr. Dennis McCullough, author of the book My Mother, Your Mother: Embracing Slow Medicine, The Compassionate Approach to Caring for Your Aging Loved Ones. Slow medicine is a philosophy and set of practices that believes in a conservative medical approach to both acute and chronic care."

Kent's post was enough to send me to Amazon.com to order Dr. McCullough's text. Lately I've been drawn to books written by physicians. (For some reason, I wanted a hard copy and opted not to go with the Kindle version.) I was surprised to see that it was published in 2008; so I am late to the game! I guess learning comes to us when we're ready for it. The book arrived a few days ago and I've been carrying it around in my briefcase, hoping I would find the time to read it. Well, yesterday I was fortunate enough to have three hours sitting in airports and two hours on airplanes - just enough time to move quickly through the volume.

It is a well constructed book. The content is terrific - although the subject matter is difficult to face. If you're like me and have parents in their 80s, then you and your family are likely dealing with exactly the challenges that Dr. McCullough addresses. Overall, Dr. McCullough has created an exceptional "how to" resource for families dealing with the care of elderly parents/grandparents. For me, what makes the book a success is the way Dr. McCullough infuses the text with emotion and interest by peppering in bits and pieces of the story of his mother's decline in health over her final years. He also includes other patient and family stories to illustrate key points. His book points out the differences between today's "medicalized care" and what I'll call personalized care that involves "personal health support and hands-on caring." Our medical system is designed to prolong life, to quickly respond to crises, and to provide heroic interventions. It is a system that stresses efficiency and high productivity, leading to an environment that is not conducive to slowing down to provide a highly personal level of care. Of course slow medicine also involves thoughtfully coordinated care, something most medicalized care has failed to achieve.

Dr. McCullough helps the reader understand and navigate through this difficult time of life when our elderly parents are seeing their power position in life decline while their adult children (that's us) are at the power stage of our lives. It is in this context that we find ourselves when we try to engage our parents in conversations about their plans for the final years of their life. Is it any wonder that these talks often degrade? I have lived this. I am living this. My parents (primarily my father) refuse to consider assisted living and continue to live on their own despite their gradually declining health and diminished ability to navigate on their own. I believe that Dr. McCullough's insights will help me and my four sisters as we help care for and coordinate care for our parents in the years to come.

"In medical systems operating according to complex institutional protocols and burdened by paper-clogging shuffles among various specialists focused on particular diseases and separate parts of the body, there is no one to reliably assume the role of knowledgeable patient advocate, no one to integrate and interpret in-hospital information and services, no one to to coordinate services for out-of-hospital care." (p.11)

Here's how Dr. McCullough explains the concept of Slow Medicine:

"Slow Medicine is a special commitment undertaken by families and health professionals working together to achieve the very fullest understanding of aging loved ones and their complex, ever-evolving needs. This, in turn, leads to wiser decision-making regarding formal medical interventions." (p.xxi)

"Slow Medicine embraces the unsung work of daily attention that is the greatest need and firmest foundation for longevity and quality of life at the farthest reach of age." (p.xxi)

I definitely recommend My Mother, Your Mother. If you'd like to check it out on Amazon, use this link. To visit Dr. McCullough's website, go to http://www.mymotheryourmother.com/. Here are a couple of links to articles about Slow Medicine:

• Dartmouth Medicine (Essay adapted from the book)
• PBS interview with Dr. McCullough
• NY Times Article
• Video interview with Dr. McCullough: Vital Living Forum - MY MOTHER, YOUR MOTHER

Dennis McCullough, M.D, is a graduate of Harvard College and Harvard Medical School, and serves as a faculty member in the Department of Community and Family Medicine at Dartmouth Medical School. He is a member of the American Geriatrics Society, the American Academy of Family Physicians, the Society of Teachers of Family Medicine, and the American Medical Directors Association.