“Slow Medicine” and the Geriatric Care Manager An Interview with Dennis McCullough, MD

by Betsy Evatt

One highlight of the incredible NAPGCM Conference in Albuquerque was Dennis McCullough’s introduction to “Slow Medicine.” The audience was moved by both the content and the inspiring presentation, mixing poetry and philosophy into a captivating whole. We came away from the conference wanting more. This interview continues the dialogue with Dr. McCullough.

INSIDE GCM – Many of us left Albuquerque espousing the virtues of Slow Medicine to our clients, families, and colleagues. It is not easy to synthesize the concept into an “elevator speech” that is concise and understandable. How would you summarize this approach in the few minutes we often have for such conversations?

Dennis McCullough – slow medicine is both a philosophy and a set of practices. The philosophy is based on knowing that elders in these “later years” have a different mix of vulnerabilities and strengths from the “younger old.” The practices of slow medicine (understanding the unique circumstances of an elder’s life and issues; always, always slowing down the process of making decisions; and continually striving to make broader and better coordinated partnerships between elder, family, “circle of concern,” and
professionals) help maintain quality of life and decision-making by keeping the elder and family in control.

INSIDE GCM – How do you suggest we introduce the subject of Slow Medicine to the physicians we work with in a way that is not offensive?

Dennis McCullough – briefly say that an approach to frailer elders called “slow medicine” is being promoted to improve quality of care. “Perhaps you or some of your staff have heard of it?” (Pause) “it emphasizes teamwork in eldercare and interests me and ‘x’ and her family. Could we take a few minutes to talk about this approach at the next visit?” (It is important to plant the seed without trying to bring up the details immediately, for the physician likely will not have enough planned time for a discussion right then. Approach the task of introducing slow medicine in the same way that you want the physician to approach patient care–slowly and carefully, allowing time for things to sink in.)

INSIDE GCM – When the Care Manager accompanies a client to the physician’s office to serve as the health advocate, our mantra needs to be “why?” and “what are the side effects?” for every invasive treatment or medication addition. What else should our script always include?

Dennis McCullough – the most important task in every visit is listening and promoting a partnership between patient, physician, and yourself. It can be useful to explain that all the questions you are asking are meant to allow you to clearly explain the physician’s thinking to family (and patient again) after the visit is over. Your goal is to get the physician to expand his or her thinking about the issues by talking a little more extensively. As you listen, appropriate questions will naturally arise. This is too complicated for there to be a general script.

INSIDE GCM -You mentioned that due to today’s fragmentation of health care, and the myriad of specialists who step in and out of the elder’s life, there is a need for an individual who says, “I am with you until the end.” You described this as a “covenantal relationship.” This is a beautiful depiction of the role a care manager takes on with a client. Can you please elaborate on this idea?

Dennis McCullough – as we think about “re-balancing” medical care we need to recognize that some important human aspects of caring for elders have been lost. Extended relationships which engender trust through proven commitment to “be there” is one of the losses of greatest impact for elders, who need to be understood in depth and over time. As this role is being increasingly vacated by physicians (brought on in substantial part by medical organizations which have created specialized “silos of care”), others are appropriately filling this void and are much appreciated for it. This aspect of the work of geriatric care managers is “bedrock” to your profession and a special gift to your clients and their families.

INSIDE GCM -What is the first step a care manager can take to introduce the philosophy of Slow Medicine to our clients and their families? Dennis McCullough – explain that your goal as a care manager is to “slow down” to the speed of the world in which your client lives so that everyone can better understand and make decisions that make sense together.

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