| August 23 2010
When an elderly person goes to a medical practitioner, he or she is often presented with numerous decisions to make, and is expected to make these decisions quickly. As most of us know, very elderly persons don’t do much of anything quickly, let alone make complicated medical decisions quickly, and this often leads to being pushed into medical procedures and tests that may or may not be of any real benefit and could be quite harmful.Thus a new philosophy of medical practice is evolving, Slow Medicine. The practices of Slow Medicine starts from understanding the circumstances of an elder’s life in order to help maintain dignity and retain the elder’s quality of life. It also helps the elder and his or her family to feel in control and make better coordinated efforts between professionals and family caregivers.
What has happened to medical care is two fold: one, the overspecialization of certain aspects of medical care has created an overload of patients on some doctors, the second is the payment system. Doctors, especially in HMO’s and Medicare Advantage plans, are paid more to see more patients and do less tests and procedures. Both of these situations cause the physician to have less time to visit with the patient and his family or care advocate, thus decisions tend to be made quickly, as the doctor has to get on to the next patient (have you ever wondered why the clients of a doctor or other medical provider are called patients instead of clients or customers? It’s because the client is who is paying the bill, which is Medicare or an insurance company!)
To frame Slow Medicine in another way, what you are trying to do is to get the doctor and other providers to give their advice to you framed in a way that looks first at the quality of life the client has now, and what the quality of life will be if he or she goes through whatever medical procedure or operation that the doctor is proposing. Here are the toughest parts about this: quality of life after a medical procedure may not be as good as it is now, but because of diseases and other co-morbidities, the quality of life is going to decline with or without this medical procedure or operation, and without this medical procedure death may occur sooner.
So, you may be thinking I’m going to die anyway, but I could live longer? Although I might be hooked up to machines and all, I would be technically alive. But would I be living or just existing? Would I be in a coma, or would I be alert and oriented and able to see my grandchildren grow up, even if I were confined to a bed or a wheelchair? In a purely financial perspective, would my family and those financially dependent on me be better off with me alive or dead? As you can see, this is not a pleasant conversation to have, and this is why we as a society have not had any real meaningful discussions about this. We continue as a country to spend more than one third of our Medicare dollars on the last two months of our lives, putting off the point of death, when many times, there is no life only existence.
Slow Medicine means to approach complex decisions slowly, but not to procrastinate so that a tacit decision gets made or that there are less options to consider. The professionals we are dealing with are busy and their financial incentives make it such that they must go fast. We must approach each appointment we have with our providers from a quality of life first and foremost, and for many the quality of life is not very good after going through so many medical procedures and tests that may have limited benefits to us. The one argument from a scientific point of view is that we need most of us to endure all these tests and procedures so that medicine advances and fines new and better procedures and perhaps cures for many diseases. Many of us die from the cure than from the diseases we have.
Slow Medicine is also another reason to have Living Will and Health Care Proxies up to date, and to have a good, long conversation with your loved ones about what you want to have happen if you find yourself in this situation. And you will find yourself in this situation if you live long enough.
