In an age of rapidly advancing technology and conflicting economic forces, it is important to guard against overuse of medical treatments and interventions, according to Pieter Cohen, M.D. He was this year’s William Goodson Jr. lecturer.
Cohen, an associate professor of medicine at Harvard Medical School, spoke Nov. 3 about “Slow Medicine,” the approach he and others promote at slowmedupdates.com. Cohen described Slow Medicine as thoughtful practice that involves patients, relies on the best evidence available and is “applied to help decrease excessive and potentially harmful interventions.”
Relatively high use of medical resources and procedures does not produce better results in many areas, Cohen said. For example, research indicates that 30 percent of U.S. knee replacement surgeries are not appropriate. That’s 200,000 major surgeries a year that should have been avoided, he said, resulting in 14,000 people needlessly suffering serious complications and side effects.
Similarly, aggressively ordering lots of CT scans and other tests can result in other overtreatments, not to mention increased anxiety and other side effects, he said, especially when tests produce false positive results.
Cohen cited research in 1973 by John Wennberg, M.D., author of “Tracking Medicine,” who identified the two main drivers of medical overuse. One is supply, so that adding physicians, specialists and hospital beds to an area will increase its use of medicine. The other is the style of medical practice prevalent in an area.
When Wennberg did his research, it was rejected by the Journal of the American Medical Association. But Dartmouth University then financed Wennberg’s work and started the Atlas Project, which examined patterns of medical use and resource intensity in the U.S.
According to Cohen, Wennberg’s conclusions have been proven correct, and Slow Medicine “digs deeper into the style issue to figure out what we can do better.” By involving patients, fully looking at options and not quickly reaching for a specific diagnosis and treatment, he said, Slow Medicine can improve care.
Economic pressures from pharmaceutical companies and medical device makers can promote overuse of some treatments, while cost pressures can curb others than might be beneficial. Slow Medicine tries to put the focus back on what’s best for the patient, which can end up saving money, but for the right reasons. It also keeps physicians from doing things mainly to make themselves feel better, and can prevent extending a treatment that works for some types of patients to others for whom it really wouldn’t be beneficial.
Cohen said Slow Medicine also can take more effort, to fully explain possible risks and rewards of different treatment choices, so that patients have more information and can know that there’s a good case to be made for more than one treatment option. In the end, more thoughtful, appropriate and caring practice can result.
Slow Medicine also is “about letting go of a specific, certain diagnosis” in favor of a more general assessment and then watchful waiting for signs of a particular ailment or for a clearer indication that treatment is needed. The slower approach often provides time for healing without intervention, he said, or provides the data needed to take the best treatment approach possible.
Cohen was the 31st speaker in the William B. Goodson Jr., M.D., Memorial Lectureship, which was established in 1987 by a group of families, patients, colleagues and friends to honor Goodson’s many contributions to medicine.
