Comments on: Richard Smith: The case for slow medicine

By: Sergio Stagnaro

Sergio Stagnaro — Wed, 26 Dec 2012 13:23:00 +0000

My “rejected”, no politically comment is posted on facebook http://www.facebook.com/bmjdotcom

By: Huw Llewelyn

Huw Llewelyn — Sun, 23 Dec 2012 09:28:00 +0000

The idea of ’slow medicine’ brings to mind the Nobel prize-winner Daniel Kahneman’s book ‘Thinking fast and slow’. Its central thesis is the dichotomy between two modes of thought: System 1, which is fast, instinctive and emotional and System 2 which is slower, more deliberative and more logical. The Oxford Handbook of Clinical Diagnosis calls these two types of thought ‘non-transparent’ and ‘transparent’ and proceeds to define (mathematically too) and teach transparent clinical thinking in a way that can be explained to patients and professional colleagues, the bulk of the book giving examples.

The ability to think transparently and to explain it in the clinical and research setting is essential if the current ills of unbridled ‘fast thinking’ are to be remedied. Failing this, evidence based medicine can only assesses the diagnostic screening process and treatment efficacy e.g. with RCTs. It cannot assess treatment effectiveness in the context of transparent evidence based treatment selection, evidence based diagnostic criteria and evidence based differential diagnosis as explained in the Oxford Handbook of Clinical Diagnosis. The entire medical profession (and not only a minority of experienced physicians as at present) must practice medicine using a transparent thought process if the current muddle caused by non-transparent ‘fast’ thinking (e.g. surrounding overdiagnosis and overtreatment) is to be sorted out.

By: Huw Llewelyn

Huw Llewelyn — Sat, 22 Dec 2012 10:42:00 +0000

The idea of ’slow medicine’ brings to mind the Nobel prize winner Daniel Kahneman’s book ‘Thinking fast and slow’. Its central thesis is the dichotomy between two modes of thought: System 1, which is fast, instinctive, imaginative and emotional and System 2 which is slower, more deliberative and more logical. The Oxford Handbook of Clinical Diagnosis calls these two types of thought ‘transparent’ and ‘non-transparent’ thinking and proceeds to define, explain and teach transparent clinical thinking in a way that can be explained to patients, clinical colleagues, journal editors, scientists and funding organisations, the main body of the book containing examples.
The ability to think transparently in the clinical and research setting is essential if the current ills of unbridled ‘fast thinking’ are to be remedied. ‘Evidence based medicine’ currently only assesses the diagnostic screening process and drug efficacy e.g. with RCTs. It does assess treatment effectiveness in the context of evidence based treatment selection, evidence based diagnostic criteria and evidence based differential diagnosis as explained in the Oxford Handbook of Clinical Diagnosis. The medical profession (and not only a minority of experienced physicians as at present) must practice medicine using a transparent thought process if the current muddle caused by non-transparent ‘fast’ thinking (e.g. surrounding overdiagnosis and overtreatment) is to be sorted out.

By: Corran Toohill

Corran Toohill — Thu, 20 Dec 2012 10:38:00 +0000

Is the converse ethical? I would suggest not.

By: Gabriele Romani

Gabriele Romani — Wed, 19 Dec 2012 20:59:00 +0000

Perhaps the slow medicine is not the solution for the medicine of this century, but I think it starts from some concepts that should be the pillars of health; fairness (not always guaranteed in our health systems) and respectfull as a medicine based on the relationship “human” between doctor and patient.

In Italy, another notable initiative is called “no thanks I’ll pay” (http://www.nograziepagoio.it/chi_siamo.htm). It is formed by a group of health professionals who rejects all forms of gifts from the pharmaceutical industry. A value of universality and equal can be achieved with greater appropriateness. How can we do this?

Surely starting from the teachings of Alessandro Liberati: research oriented towards the needs of patients.

Gabriele Romani (Local Health Autority Reggio Emilia, Italy)

By: Dylan Summers

Dylan Summers — Wed, 19 Dec 2012 13:42:00 +0000

“We need, he said, to encourage a healthy skepticism about the medical
market and to help people understand that medicine is far from being an
exact science.”

Is this ethical, though?

Less implied effectiveness of treatment = less placebo effect = worse outcomes