By José Carlos Campos Velho
Originally published on November 07, 2019: https://www.slowmedicine.com.br/o-que-e-slow-medicine-e-o-que-nao-e/
“Everything in us is in our concept of the world; to modify our concept of the world is to modify the world for us, that is, it is to modify the world, because the world will never be, for us, anything different from what it is for us.”
We are often asked about the concept of Slow Medicine. What is Slow Medicine anyway? We usually answer that it is difficult to establish a concept, and we ponder that Slow Medicine is a philosophy and a group of principles that can guide medical practice, opting for a more cautious and pondered conduction of medical care (and speaking more broadly, of health care in general, including those provided by other health professions), where Time plays a precious role. Time is the first principle of Slow Medicine. These principles were elaborated by the Dutch Slow Medicine Institute and freely translated into Portuguese by the site editor, José Carlos Campos Velho.
At other times we have chosen to speak of the 4 Pillars of Slow Medicine: time, the doctor-patient relationship, the sharing of decisions, and the considered use of technology. A concept of Slow Medicine should also incorporate the proposals of the Slow Medicine Manifesto, prepared by the Italian Slow Medicine Association, which proposes a Sober, Respectful and Fair Medicine: doing more does not mean doing better; people’s values, expectations, and desires are indifferent and inviolable; and a good quality and appropriate care is guaranteed for all.
Dennis McCullough, perhaps the leading disseminator of Slow Medicine in the US, suggested that Slow Medicine can be considered a philosophy, a practice, and a metaphor, focusing particularly on the care of the elderly.
Possibly the closest to a definition of Slow Medicine is the concept devised by Pieter Cohen and Michael Hochmann of Updates in Slow Medicine, who suggests that Slow Medicine “is a practice of medicine in which one is careful to interview (and examine) patients, careful to weigh the risks and benefits of diagnostic and therapeutic interventions that are unhurried to intervene when symptoms are undefined, that uses clinical observation as an important diagnostic and therapeutic strategy, and that is cautious about adding new diagnostic tests and therapies until evidence establishes their value.
Our theoretical reference is Evidence-Based Medicine, and although we are sympathetic to the adoption of integrative practices that can improve people’s well-being, promote health, and reduce the excessive use of medicines and medical interventions; Slow Medicine is not configured as an alternative practice. We have chosen to avoid the use of the expression “Integrative Medicine” in our site because under this expression there are currently a lot of questionable propositions from the scientific point of view and without other criteria that could support its use when it comes to health care of the human being. The expression Integrative Medicine has become a mixed bag, where forms of medical care represented by Traditional Medicine coexist, medical rationalities strongly rooted in the culture and history of the countries where they were created and elaborated through centuries, with proposals such as orthomolecular medicine (an outdated term, a practice no longer recognized by the Federal Council of Medicine), anti-aging medicine, and a myriad of other propositions. Many times, these practices are offered by professionals from outside the health field, with precarious and little systematized training.
Expressions such as Lifestyle Medicine, where some serious groups seek to research and propose adequate approaches to the much-needed lifestyle modifications (essential in the prevention and treatment of a series of diseases), have been losing strength due to their erratic and not very careful use. What prevails are economic and professional interests and the expression ends up being the bait for the person to “sell their fish”, particularly in the no man’s land that are the social networks and their role in contemporary society.
A State Of Mind: listening, examining, refelecting
For this reason, we believe it is appropriate to take a position on the expression and concept of Slow Medicine. The expression Slow Medicine, in particular expressed by the hashtag #slowmedicine, has been used in a not very rational way, with thousands of publications whose objectives are far from the ideas, concepts, and principles we have set out above. We suggest a little caution when you view this expression. We have to take care of it (and preserve it) and that depends on all those who identify with its purpose. Yoga is an excellent way to exercise, seek balance, to nurture a spiritual practice. However, Yoga is Yoga, not Slow Medicine. Drinking tea is great, but it is not Slow Medicine. Drinking coffee with friends is drinking coffee with friends, not Slow Medicine. Walking in nature, climbing a mountain, is advisable and pleasant. But it is not Slow Medicine. Slow Medicine is not a product for sale, it is not a marketing product, or a form of advertising to attract customers. It is not a medical specialty. It is not a guideline or a protocol. It is perhaps a state of mind, a way of practicing medicine rationally and thoughtfully. It is listening, it is examining, reflecting, and sharing decisions.