By José Carlos Campos Velho
Originally published on September 28, 2017: https://www.slowmedicine.com.br/slow-medicine-nao-e-uma-especialidade-medica-saiba-por-que/
Is Slow Medicine a medical specialty?
The Slow Medicine Movement has its origins in Italy. The expression was coined by Alberto Dolara in 2002 in his article “Un invito ad una Slow Medicine”, in which he pointed out that, like food, as proposed by the Slow Food Movement, a reconstruction of health-related values was needed, particularly a slowing down of the decision-making process in some clinical situations common in medical practice.
Dr. Dolara’s appeal was heard. Several initiatives around the world have embraced this principle and today we have concrete international actions, especially in Italy, the USA, and Holland. In these countries, Slow Medicine has been constituted as a medical work philosophy, congruent with several other campaigns, among them Right Care, headed by the Lown Institute and Choosing Wisely, which seek to establish a new paradigm in health care.
Brazil today has one of the most powerful and active initiatives in the world, translated into Portuguese as Medicina sem Pressa (Medicine without haste). The Slow Medicine Brazil website contains a large amount of systematized information on the subject. We can say that Slow Medicine today has a Brazilian language, consistent with the principles and philosophy that guide the international movement.
The media’s attention has turned to the proposal, with reports and articles exploring the subject. We have participated in countless scientific meetings and congresses in the health area, and we have been present in the academy and articipating in the training of future health professionals. We believe that Slow Medicine principles of a more humanized and attentive medicine, sober, respectful, and fair, are confluent with the desire of society as a whole. And it is a reason to rejoice that its principles are gaining a voice, becoming widespread among physicians and health professionals, who begin to base their practice on its premises of a more cautious and pondered medicine.
However, we are concerned about the emergence of some initiatives that have sought to commercialize our ideas, trying to transform Slow Medicine into a product to be sold, commercially exploiting its concepts. We affirm that Slow Medicine is not a medical specialty and that no professional can claim to be a “Slow Medicine specialist”. As the document Slow Medicine, an Evolving Concept states, the Slow Medicine professional “…adopts a rigorous ethical stance; the patient and their loved ones are at the center of interventions aimed at increasing psychological and physical well-being and autonomy in decision-making. He pays close attention so that patients are not manipulated or used to obtain advantages for himself, so as not to take advantage of their fragility to create dependence, so as not to offer wrong or incomplete information, so as not to denigrate other forms of treatment, so as not to believe or induce the patient to believe that he possesses the “true” and complete knowledge, and so as not to fail to be aware of his limits”. He continues “…the Slow Professional can recognize what he does not know and avoids adopting postures of self-promotion.”
Dr. Carlos Sacomani, urologist and sympathizer of our initiative, recently published this text in his Facebook profile: “…. As professionals, we are entitled to remuneration for our services. We have commitments, we pay bills, we invest in our knowledge. I will not discuss here the existing and proposed models of medical remuneration. I will deal with another subject: Medicine as a business (…). Under no circumstances, the duty to the patient, the dedication, and the rendering of the service itself can be put in second place (…). It is unethical that we bring more discomfort to the patient and the family than the disease itself. Our role is to welcome and provide security. We must be well remunerated, yes. But defining the limits of this remuneration is perhaps one of the challenges of modern medicine.”
Therefore, such initiatives are spurious and conceptually hurt the principles of Medicine Without Haste. Our response to these ventures is to continue our journey, always guided by ethics and by the correctness of our attitudes, divulging our concepts, which are open and available to be appropriated by all those who wish to be part of this journey.