Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About CFP Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About CFP Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
EditorialCommentary

Family medicine, fast and slow

Nicholas Pimlott
Canadian Family Physician July 2018, 64 (7) 486;
Nicholas Pimlott
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading
Figure1

If everything seems under control, you’re not going fast enough.

Mario Andretti

Late last autumn in my office I saw Barbara, a 63-year-old woman who a year earlier had been diagnosed with an aggressive form of pancreatic cancer. The cancer had recently spread to her liver and her oncologist had recommended that she enrol in a clinical trial of a new chemotherapeutic regimen. Overwhelmed with fear and uncertainty while at the oncologist’s office, she had booked the appointment with me, her family physician for many years, to discuss her options. A few days earlier she had e-mailed a copy of the treatment protocol, allowing me the time to consider the risks and benefits and to think about the questions I should ask to help her make the right decision.

Later that same day I saw David, a 54-year-old man, for his periodic health examination. He was particularly concerned about being screened for prostate cancer, as an office colleague had recently been diagnosed with the disease.

As a young family physician running a family medicine inpatient service at a busy downtown teaching hospital and building a practice and an academic career while juggling the responsibilities and roles of raising 3 young children, Mario Andretti’s quotation was one of my favourites. I wore it like a badge of honour. For the first 15 years of my career things were rarely under control.

When I look back, in my professional life every working hour was divided into 15-minute pieces that made it feel like I sprinted through each day. In large part this was driven by a fee-for-service model of payment that was arbitrarily determined by insurance service codes based on diagnostic complexity—a capitalistic model where money is tied to a clock.1 The effect of this was “one visit, one problem” thinking and a lack of attentiveness that is now epidemic in our society.2 This worked out well enough if the presenting problems were simple—a rash, an ear infection, or a sore throat—but for most of the patients I saw each day it was likely not enough.3

Almost a decade ago, with the establishment of family health teams in Ontario and the move to a capitation model of payment that coincided with the implementation of the electronic medical record in our clinic, I was serendipitously forced to begin to practise what I called slow medicine—reducing the number of patients that I saw in the course of the day in order to adapt to the considerable change in our model of care. It turns out that, like most good ideas, someone else had thought about it long before it occurred to me. Like the “slow food” movement, slow medicine also has its origins in Italy, heralded by the publication of a paper in the Italian Heart Journal calling for a more considered approach to cardiac interventions.4 The slow medicine movement has grown, especially in Europe, and has as its tenets making time for listening and understanding, individualizing care, practising shared decision making, and focusing on “positive health,” among others.5,6

As a family physician with an aging practice, faced daily with patients with complex and interacting health problems,7 being able to practise slow medicine when it is needed has been a boon. The benefits of slow medicine have been manifold, for both my patients and me. These include being more attentive and fully present at each encounter, increasingly using a narrative8–10 and trauma-informed approach to the care that I provide,11 and having the time to help my patients navigate important medical decisions—whether it is to enrol in a clinical trial of chemotherapy or to fully engage in shared decision making for preventive care, such as the choice to be screened for prostate cancer (page 502.).12

There is so much at stake when we inappropriately practise fast medicine and fail to slow down when needed: regret on the part of the person, regret on the part of the doctor, and the failure to savour the meaningful work that we do.

Footnotes

  • Cet article se trouve aussi en français à la page 487.

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Stein M
    . When medical care is delivered in 15-minute doses, there’s not much time for caring. Washington Post 2015 Nov 13. Available from: www.washingtonpost.com/opinions/when-medical-care-is-delivered-in-15-minute-doses-theres-not-much-time-for-caring/2015/11/13/85ddba3a-818f-11e5-a7ca-6ab6ec20f839_story.html?noredirect=on&utm_term=.fc10947927c8. Accessed 2018 Jun 7.
  2. 2.↵
    1. Crawford MB
    . The world beyond your head. On becoming an individual in an age of distraction. New York, NY: Farrar, Straus and Giroux; 2015.
  3. 3.↵
    1. Beasley JW,
    2. Hankey TH,
    3. Erickson R,
    4. Stange KC,
    5. Mundt M,
    6. Elliott M,
    7. et al
    . How many problems do family physicians manage at each encounter? A WReN study. Ann Fam Med 2004;2(5):405-10.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Dolara A
    . Invitation to slow medicine [article in Italian]. Italian Heart J Suppl 2002;3(1):100-1.
    OpenUrl
  5. 5.↵
    Slow Medicine [website]. Torino, Ital: Slow Medicine; 2016. Available from: www.slowmedicine.it/index.php/it. Accessed 2018 Jun 7.
  6. 6.↵
    1. Smith R
    . The case for slow medicine [blog]. BMJ Opinion 2012 Dec 17. Available from: blogs.bmj.com/bmj/2012/12/17/richard-smith-the-case-for-slow-medicine. Accessed 2018 Jun 7.
  7. 7.↵
    1. Pimlott N
    . Considering the alternatives. Can Fam Physician 2018;64:408. (Eng), 409 (Fr).
    OpenUrlFREE Full Text
  8. 8.↵
    1. Zaharias G
    . What is narrative-based medicine? Narrative-based medicine 1. Can Fam Physician 2018;64:176-80.
    OpenUrlAbstract/FREE Full Text
  9. 9.
    1. Zaharias G
    . Narrative-based medicine and the general practice consultation. Narrative-based medicine 2. Can Fam Physician 2018;64:286-90.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Zaharias G
    . Learning narrative-based medicine skills. Narrative-based medicine 3. Can Fam Physician 2018;64:352-6.
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    1. Purkey E,
    2. Patel R,
    3. Phillips SP
    . Trauma-informed care. Better care for everyone. Can Fam Physician 2018;64:170-2. (Eng), 173–5 (Fr).
    OpenUrlFREE Full Text
  12. 12.↵
    1. Dickinson JA,
    2. Pimlott N,
    3. Grad R,
    4. Singh H,
    5. Szafran O,
    6. Wilson BJ,
    7. et al
    . Screening: when things go wrong. Can Fam Physician 2018;64:502-8. (Eng), e299–306 (Fr).
    OpenUrlFREE Full Text
PreviousNext
Back to top

In this issue

Canadian Family Physician: 64 (7)
Canadian Family Physician
Vol. 64, Issue 7
1 Jul 2018
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Family medicine, fast and slow
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
Citation Tools
Family medicine, fast and slow
Nicholas Pimlott
Canadian Family Physician Jul 2018, 64 (7) 486;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Family medicine, fast and slow
Nicholas Pimlott
Canadian Family Physician Jul 2018, 64 (7) 486;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • Screening: when things go wrong
  • La médecine familiale rapide et lente
  • Scopus
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Commentary

  • The “direct” dilemma
  • Cannabis legislation provides an opportunity to strengthen primary care substance use counseling
  • Our fight against climate change
Show more Commentary

Editorial

  • Notre lutte contre les changements climatiques
  • Our fight against climate change
  • Resident suicide
Show more Editorial

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2019 by The College of Family Physicians of Canada

Powered by HighWire