Slow Medicine
| Research from the Dartmouth Medical School, as highlighted in a recent NY Times article upon which this article is based, looks at how older Americans, while thankful for all the modern miracles of medicine, now are beginning to say no to many and repeated medical interventions. Slow medicine encourages a less aggressive and less costly approach to medical care at the end of life. Slow medicine is distinct from hospice care and yet shares the feature of comfort rather than a limited cure. The judgement of what is a medical emergency is difficult at times for the non-professional so someone living at home or in assisted living, in contrast to a nursing home, probably will just call 911 and not as easily be able to choose other options. The Dartmouth program educates nursing staff and families on making these kinds of judgements. In turn this might be better for many elderly patients. Quoting from the Times article: "Charley Gieg, 86 at the time, was suffering from a heart problem, an intestinal disorder and the early stages of Alzheimer's disease when doctors suspected he also had throat cancer. A specialist outlined what he was facing: biopsies, anesthesia, surgery, radiation or chemotherapy. Ms. Gieg doubted he had the resilience to bounce back. She worried, instead, that such treatments would accelerate his downward trajectory, ushering in a prolonged period of decline and dependence. This is what the Giegs said they feared even more than dying, what some call "death by intensive care." Such fears are rarely shared among old people, health care professionals or family members, because etiquette discourages it. But at Kendal - which offers a continuum of care, from independent living apartments to a nursing home - death and dying is central to the conversation from Day 1." Physicians get paid for carrying out tests and procedures and not for discouraging them and with Medicare willing to pay the bill it makes one less likely to pass up free care and may have up until now skewed the patients decision to aggressive intervention. Here I believe is where a primary care Internist or a Geriatrician can make a big difference in the twilight years of a patient's life. He can put into perspective, from experience, which interventions are more likely to help the patient and allow the patient to see what pitfalls exist in each possible path taken. It is up to the patient and his family to make these decisions; however, unless they have knowledgeable and unbiased guidance it could be the wrong choice. It may markedly impair their already poor quality of life and they may be pawns in a system, which rewards hospitals and doctors at the expense of the right thing to do and at the expense of the American taxpayer. | ||||||||||||||||||||
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