How to guard against over diagnosis and over treatment
We often associate high-quality health care with speed and sophisticated medical technology—elements that have certainly proven crucial during the COVID-19 pandemic. Quick testing and high-tech interventions can save lives for patients fighting the deadly virus. But fast-action responses, powered by the latest pricey innovations, can be the wrong approach for many conditions; we need to remember the benefits of “slow medicine,” a different kind of care that’s gained favor in recent years..
Popularized by writers such as Victoria Sweet, MD, (Slow Medicine: The Way to Healing) and Dennis McCullough, MD, (My Mother, Your Mother: Embracing Slow Medicine), this approach promotes better shared communication and sufficient time and observation over time to meet patient needs, while preventing the overuse of technologies that don’t bring value.
Slow medicine can be good for all ages, but it’s especially suitable for older patients who are at high risk for harm due to overdiagnosis and overtreatment. It allows us to avoid “medicalizing” normal changes of aging—that is, misinterpreting normal aging as diseases that require medical attention. Examples include decreased levels of estrogen in women following menopause, or lower levels of testosterone in men as they age. Perceiving these and other age-related conditions as problems that need to be “cured” can lead to unwarranted and sometimes harmful overtreatment.
Some have described such forms of medicalization as “disease mongering,” extending the boundaries of illness to expand markets for new products. Such marketing manipulates our culture’s fears of aging and its obsession with staying forever young. People who fall prey not only waste money on ineffective measures; they may also suffer from unnecessary medical treatments that have risky side effects.
While slow medicine represents the antithesis of medicalization, it doesn’t mean ignoring symptoms you may find troublesome. It makes sense to talk with your health care team about changes that worry you. Doing so allows them to help you manage minor issues while ruling out medical problems that really can benefit from more intensive treatment. It’s also important to work closely with your health care team to manage chronic conditions such as osteoarthritis and high blood pressure. Ideally, this involves asking questions and even “pushing back” if you feel you’re getting too much medicine or too much intervention. And, of course, this requires providers who don’t feel the need to always take fast action toward ever more care leading to overdiagnosis and overtreatment.
Those who practice slow medicine also typically try to keep elderly patients out of hospitals and emergency departments whenever possible, recognizing that an inpatient stay—with all its unfamiliarity and disruptions in daily routines—can be highly stressful. In fact, our research revealed that hospitalization can increase an elderly person’s risk for dementia.
Telemedicine, on the other hand, is proving to be a real boon to older patients and their providers. Recent surveys have shown that providing “remote” care to patients in their homes via phone, Zoom, or online chats—a practice made necessary by the social distancing during COVID—is actually quite compatible with “slow medicine,” especially when it allows watchful waiting, the so-called “tincture of time.” Indeed, many older patients and their doctors now report high satisfaction with the quality and convenience of their “remote” visits and look forward to seeing them continue.
Bottom line? Let’s all learn from the COVID era: There’s a time for fast and slow medicine.
Dr. Eric B. Larson is a senior scientist at Kaiser Permanente Washington and author of Enlightened Aging: Building Resilience for a Long, Active Life (Rowman & Littlefield, 2017).