“The trouble with the rat race is that even if you win, you’re still a rat” —Lily Tomlin
The image of a rat on a wheel is ubiquitous to analogies of lifestyle dysfunction. The rat race is rich with symbolism of people who are captive to mandates of authority, to limited choices, and access to meet individual needs. There appears no way to get off the wheel—it’s moving too fast.
Such is the plight that we, healthcare practitioners and consumers, find ourselves in: an exhausting lifestyle that leaves little to no time for quality relaxation. The risk of personal dissatisfaction, in both work and private life, runs the gamut all the way to the end of the spectrum towards burnout syndrome, depression, and suicide.
Running the same maze and getting the same results leads to boredom and apathy. Apathy and indifference are a breeding ground for mistakes. We make mistakes in judgement and choices when we don’t care. We make mistakes when we move too quickly without giving pause to contemplate the whole picture before we act. Outcomes are a value upon which we base our self-worth. When the maze we find ourselves in does not lend itself to yielding value-based outcomes, when the monetary goal is dependent upon how many circuits you complete, eventually you will find that, after all is said and done, at the end of the rat race, you will still be a rat.
Never has the time been more ripe than now to introduce “slow medicine,” which expert Michael Finkelstein, MD describes as “identifying the root cause of our health challenges, then creating a thoughtful, step-by-step, and long-term response to it.”
The concept of slow medicine was introduced by Alberto Dolara, MD, a cardiologist in Italy who advocated for new approaches to the use of heart devices, in a 2002 paper published in the Italian Heart Journal. According to the abstract:
“In clinical practice, hyperactivity is often unnecessary. Adopting a strategy of “slow medicine” may be more rewarding in many situations. Such an approach would allow health professionals and particularly doctors and nurses, to have a sufficiently long time to evaluate the personal, familial and social problems of patients extensively, to reduce anxiety whilst waiting for non urgent diagnostic and therapeutic procedures, to evaluate new methods and technologies carefully, to prevent premature dismissals from hospital and finally to offer an adequate emotional support to the terminal patients and their families.”
Slow medicine stemmed from the “slow food movement” in Italy, as the culture’s pleasure of savoring a delicious meal shared with family was considered healthy and healing. Take, for example, chicken soup. The process of selecting, preparing, and enjoying fresh foods with loved ones has a certain therapeutic effect, and the truth remains that the feelings are, in fact, healing. It is this concept of slowing down to take care in the process, as well as the outcomes, of patient care that is central to slow medicine.
In the article If Slow is Good for Food Why not Medicine? , author and primary care doctor John Henning Schumann, MD describes slow food and, by extension, slow medicine. He espouses the idea that it is generally understood that cooking, nutrition, and eating should be intentional, substantive, and mindful. Schumann says that he is now seeing a medical version of slow food “bubbling up in response to industrialized, hypertechnological, and often unnecessary medical care that drives up costs and leaves both doctors and patients frazzled.”
Schumann struggles with the inherent contradictions of efficiency in order to save lives and “the real world of medical practice, which breaks our time into eight-minute increments.” He understands the need for them to take the time to think through their actions and consider potential consequences but then there is the wheel, and the maze, to get through.
Schumann adds to the chorus of slow medicine advocates, “slow medicine adherents will be quick to tell you that the vast majority of CT scans ordered in the emergency departments are of little value, most of the time adding only unnecessary coast and radiation risks for patients. Antibiotics for colds are another example of harmful waste. They don’t work for viruses, and patients who take antibiotics are more likely to develop resistant bacteria, diarrhea and other symptoms that lead to avoidable office visits and hospitalizations…. As I’ve learned more about slow medicine”, he said, “I’ve found it comes in many flavors.”
One skillful strategy in slow medicine, one flavor, is utilization of time at the bedside. Taking the time to listen to your patient, to their story, is where the nuggets of truth are revealed. Samuel Hahnemann, MD, in his seminal work Organon of The Medical Art, posits this:
To be a genuine practitioner of the medical art, a physician must:
- Clearly realize what needs to be cured in diseases, that is, in each single case of disease (discernment of the disease, indicator).
- Clearly realize what is curative in medicines, that is, in each particular medicine (knowledge of medicinal powers).
- Be aware of how to adapt what is curative in medicines to what he has discerned to be undoubtedly diseased in the patient, according to clear principles.
Dr. Hahnemann describes the physician’s highest and only calling “to make the sick healthy, to cure, as it is called. The highest ideal of cure is the rapid, gentle and permanent restoration of health; that is, the lifting and annihilation of the disease in its entire extent in the shortest, most reliable, and least disadvantageous way, according to clearly realized principles.”
Throughout the Organon, Dr. Hahnemann uses various terms to refer to different modes of knowledge, understanding, and perception. These include references to intellectual knowledge as well as knowledge based upon participative experience. The participative experience of a slow consultation allows for the development of the narrative. The patient’s story of how the disease, the chief complaint, developed. It is within this context that the astute physician understands the true nature of the condition and the strength of the vital force of the person suffering.
The concept of the vital force or life force is as fundamental within classical homeopathy, as qi is within Chinese medicine and other forms of energy medicine. The pre-eminent researcher, Dr. Iris Bell et al investigated the Strength of the Vital Force in Classical Homeopathy: Bio-Psycho-Social-Spiritual Correlates Within a Complex Systems Context.
In complex systems theory, the whole is more than the sum of its parts; and the whole system, the person, expresses properties not seen or predicted from those of its constituent elements, such as molecules, cells, organs. Therefore, careful, unprejudiced observation must prevail.
Dr. Bell’s research concluded that homeopathic vital force ratings reflect better perceived mental function, energy, and positive dimensions of the individual, beyond absence of disease. These qualities of healthy vitality allow one to get off the wheel, to slow down, and choose conditions that reflect freedom in body, mind, and spirit. The positive dimensions of a healthy person with good energy and enhanced mental function clearly distinguish an individual from a rat. As such, the concept of slow medicine may have merit. Time will tell.