Below, Kent Bottles, M.D. reflects on the difference between “slow medicine” and what he calls “UCLA medicine.” (For the full post, see “Kent Bottles’ Private Views” )
“I have been thinking about the difference between slow medicine and UCLA medicine. It has made me realize how complex and difficult it is to transform American health care so that we lower per-capita cost and increase the quality of our lives. And yet we must achieve these two goals.
“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.
“McCullough describes slow medicine as ‘care that is more measured and reflective, and that actually stands back from rushed, in-hospital interventions and slows down to balance thoughtfully the separate, multiple and complex issues of late life.’ Shared decision-making, community and family involvement, and sophisticated knowledge of the American health care system are some of the slow medicine practices that sharply contrast with UCLA medicine.
“UCLA medicine is the status quo where the hospital is the center of the medical universe; where care is often uncoordinated and hurried, and where cure is the only acceptable outcome for both patient and physician. I call it UCLA medicine because the CEO of that well-regarded medical center was quoted in a New York Times Sunday Magazine article as saying, ‘If you come into this hospital, we’re not going to let you die.’ This is a statement that puzzles me as an old time anatomic pathologist.”
I would add that I find the UCLA CEO’s statement more than puzzling; I find it frightening.
I can’t help but think of the doctor who explained: “Once you’re in the hospital, you’re in ‘the system.’” I imagine a prison door closing behind me. I am now in a place where people no longer ask me what I want. Instead, they tell me: “This is what we’re going to do.”
Of course, Bottles goes on to acknowledge that “there are times (serious acute illness correctly diagnosed where there is an evidence-based treatment that has a good chance of success) when I hope I am treated in UCLA’s ICU or operating room by UCLA specialists. However, there are also times as I get older that I hope I end up living in the Kendal-at-Hanover retirement community cared for by a wise and experienced geriatrician like Dennis McCullough and the community’s nurse practitioner; I want my providers to take things slowly and listen to what I want out of life.”
