This post is a result of collaboration with one of the sharpest healthcare minds – Dr Nathalie Martinek. Nathalie is a physician & healthcare professional, wellbeing mentor and educator from Melbourne.
That’s how it works, right?
You welcome your frightened patient nicely to show your empathic side right from the start. After you have negotiated a shared agenda they give a brief explanation of the history while you enter data on the computer.
A few more close-ended questions, some physical checks if necessary, and everything is set and done for the final act.
You’re ready to deliver the perfect solution, one that you come up with after processing all the information in eight to fifteen highly intensive minutes.
After being treated, and hearing what you had to say, the patient leaves the office space for another person who has come for solution also.
The line is moving, as long as you generate “solutions” fast enough, everyone will be satisfied.
Yeah, that’s how it works in today’s healthcare, and that is exactly the opposite of how it should.
I can’t underestimate the power of fast decisions when they’re needed – when a patient is bleeding, you need to stop a haemorrhage.
But in 90% of regular doctor-patient interactions, slowing things down is a much better option.
It allows you to scratch below the surface, to find what else is happening beyond physical symptoms. You’re in a better position to discover how patients perceive their diagnosis and how possible treatments might affect the most important aspects of their lives.
When you’re treating the person, these things are equally important as “being right”.
They directly influence outcomes and the patients’ perception of you. And these are just the most obvious reasons why every doctor should practice slower medicine.
Yes, even you. Even if you don’t think you can.
But… “No one is doing it, so why should I?”
I won’t lie to you, it will look strange if you slow down and everyone else is in a rush.
You will probably be criticized if you try to maintain prolonged contact with a patient or end the appointment without prescribing something.
Patients will also be surprised by the fact you want to put more time into their healing process. They’re used to doctors who have “out of the sleeve” solutions for their symptoms.
But does that mean you shouldn’t slow things down for a bit?
Absolutely not !
Unique approaches always provoke reactions and that’s why most doctors decide to shrug their shoulders and move on. We can’t blame them, but we shouldn’t use them as a reference either.
“No one is doing it” isn’t an excuse!
It isn’t even a truth. I know because I experienced it.
I was a patient of doctors who slowed things down:
- Dr. Winkler, state of the art orthopaedic surgeon who additionally used email communication to understand my side and make slower and better decisions.
- Dr. Koluder, infectologist with over 25 years in practice. She hosted very long visits with the emphasis on asking questions and trying to adjust treatment to my dynamic life habits.
They both embedded slow medicine principles in their unique situations. As a result, of all the doctors that have treated me in the last 10 years, I’m most grateful to these two.
They didn’t do what everyone else was doing, they stood out in the crowd.
But, But…”it isn’t aligned with reimbursement policy”
It’s a fair argument, but not completely correct.
Political-industrial healthcare is designed to run, rush and prescribe. So obviously, reimbursement of slower care is at the very bottom of their priorities.
Still, as we know, there are few options to reimburse slower care in the vast majority of developed world countries.
If you’re in the U.S, your obvious option is to enter and win a “code war”. Before joining a “code war” consider IFs and ORs for codes related to prolonged and tele-health services in your state.
I know it isn’t a great one, but it is an option.
Luckily, there are other options too.
If you really want to innovate your care model, removing the middleman is the best one.
It’s impossible to completely adjust the tempo to your patients and yourself if you allow insurers and governments to blueprint your work.
There is a small but increasing number of brave doctors who have done this recently.
Take the example of Venu Julapalli, founder of an active private practice in gastroenterology in Houston, Texas.
After running his gastroenterology practice under the traditional insurance model for over ten years, he came out of all insurance networks in April 2016.
This allowed him to market disruptive pricing models which are based on transparency and the unique needs of every patient. Here’s a screenshot from his patient services page.
If Venu found a way to innovate reimbursement and pace of care in America – the land of speed and instant gratification, than probably everyone can find some holes and opportunities to do the same.
4 Critical Reasons Why You Should Slow Down With Your Patients
Are you any closer to considering slow medicine as a valid idea?
Good, than we can talk about the benefits it brings.
The truth is, it can be a real game-changer for doctors.
Doctors who practice this way claim wide list of advantages that come with it. These are the four most common…
The moment you slow down the tempo of your work you will become a better teacher. I know that sounds uber-simplistic, but just think about your previous learning experiences.
Do you learn better when you’re overwhelmed with informations or when you receive informations in smaller chunks over a period of time?
There’s no difference with patient learning experience.
Their brain is like a glass of water, when you pour in too much information in a short period of time, it’s just gonna confuse them.
But if you pour in the right amount informations over a few separate chunks of time, allowing them to think about everything and ask questions, they will end up with knowing more about the conditions and treatments.
I know that teaching patients isn’t always your highest priority, but slowing things down will honour you with the opportunity to share your knowledge more often.
Often, you will be able to return back to the forgotten roots of your profession – videre unum, noli unum, docent; see one, do one, teach one.
2.Privilege to See Non-number Side
In additional to the increased opportunities to teach, you will also have more opportunities to learn.
The biggest difference maker is an the amount of important information about a person you could obtain. And no, I am not referring to more lab results or screenings.
This information can’t be measured or detected on any scan, screen or test.
It’s the information that your patient reveals to only you when they sense that your attention isn’t on the patient backlog in the waiting room, that pile of unfinished paperwork or that you’re rushing to get through it all.
It’s the information that patients share with you, only when they feel comfortable enough in your company.
When you follow a hunch and ask your patient with chronic headaches if something stressful is happening at home and she nods tearily before describing her situation.
The headache might still be there but she feels relieved to have gotten that off her chest and thanks you for the referral to see a family therapist.
3.No more forced decisions
Unlike rushed medicine, which forcing you to:
*Come-up fast with diagnosis for problem that developed over several years.
*Conclude every meeting with a treatment that ends the patient’s symptoms.
Slow medicine is a forced-decision agnostic.
It supposes that a decision could also be a CHOICE TO WAIT before rushing into something unwise or uncertain. A culture of haste can be replaced with one of calm and slow deliberation where appropriate.
When you perform without a chimp on your shoulder several opportunities will open.
You will have more time to pause, access to the observer-self and take notice of what else is happening beyond what the charts are showing. You can perhaps even investigate options which aren’t part of current protocols, or include other experts in a shared decision-making process.
Patients will have opportunity to share knowledge about themselves, what they know, want and what matters in their life.
As a result, you end up with a clearer picture of what is influencing their health, and you feel more invested in proposing a care plan that enhances their wellbeing.
You end up with an opportunity to make slower decisions that suit the patient’s situation better.
4. You notice the difference you’re making in patient’s lives
When you decided to become a doctor, you probably made this decision for a reason. Perhaps your father struggled with diabetes, your grandma died of cancer, or you just have a strong sense of service.
In each of these cases, making a positive impact on people’s lives is very important to you.
Unfortunately, today’s healthcare isn’t designed to show you the real impact of your work. After the patients leave the hospital, every trace is lost.
The most you can expect is an outcome chart, but it will only show numbers, not the real impact. You will not feel the patient’s appreciation and positive energy simply by looking at numbers.
Are you wondering how slow medicine helps with this?
Dr. Jeff Kane described this best in his podcast about “outcomes”:
You wonder why we didn’t emphasise outcomes decades ago? Well we did, when healthcare was simpler, when it involved just practitioner and patient in a relationship that lasted longer than 15 minutes. As that relationship went on, the outcome was continuously obvious.
He actually speaks about slower relationships and medicine where doctors and patients maintain their contact without intervening third parties.
In such relationships, you get important updates from patients and you are always aware of how treatments affect them in the long term.
You hear from your patient not just when something goes wrong, but also in those more gratifying situations—when you helped them to remove the biggest obstacles from their lives.
Heal slower, reap the benefits
Despite what you hear, slow medicine isn’t quackery or something new and unrealistic.
It is a doctrine that improves your ability to facilitate healing, and the way you feel about yourself while you are following your life’s path.
And healing is the ultimate outcome of an effective patient-doctor relationship, isn’t it?
If you decide to go with it, you don’t need to label yourself as a slow medicine practitioner or brag about it.
None of the doctors we mentioned in this post do that. They just get on with it.
They’ve made a choice to invest time in maximising the learning opportunity they had about each patient’s unique situation to discover the best ways to help them heal.
It works today just like it worked 50 years ago, it works in America just like it works in every other corner of the world.
Why wouldn’t it?