New England Programs II: Slow Medicine and Dr Dennis McCullough

I’ve held off posting about Dr. Dennis McCullough, whom I visited back in September, because I wanted to finish his book and also hear him speak.

He visited us in Vancouver this past weekend and gave two impressive presentations, so I’m ready to say a bit about this frailty-primary-care senior statesman and advocate, colleague, and friend.

Dennis went to Harvard on an ice hockey scholarship and was apparently a very good player. He carried on to Harvard Medical School, and then (against the stream of elite-school graduates at the time) opted for family practice over specialty, and came to Canada as a Family Practice trainee at the University of Western Ontario.

Personal experiences with his mother and with a disabling illness of his own added to his determination to change the course of the deadly impersonal technologic one-size-fits-all medicine he saw being practiced everywhere. So he has over the years built up a philosophy of humane care which he calls “Slow Medicine”, along similar lines to other movements including Slow Food, Slow Cities, and so on. Taking one’s time about things.

A senior faculty member at Dartmouth University in Hanover New Hampshire, Dennis has written a lovely book My Mother, Your Mother, and is a frequent and well-received lecturer all over the US and Canada. He supervises at Kendal-at-Hanover, an elders’ community near his home. The book is a practical guide to the events of aging and frailty, informed by an original and beautifully pragmatic philosophy.

Sitting down at a presentation by Dennis (he did one to the general public and one to geriatric physicians here in Vancouver) you confront a neatly-bearded lively scholarly gentleman who seems part philosopher and part… almost clergyman as he quietly brings his message to an audience. He has avoided developing the kind of slick delivery which makes many of us look like would-be standup comics or politicians whose reflective polish may obscure the original motivation and the message. Listening to Dennis, you feel he’s really talking to you (you can confirm this by checking out a video of him speaking here ).

What he says is not specifically program-oriented but contains a theory or philosophy of aging and practice of medicine. There are eight “stations” which usually proceed in sequence: stability, compromise, crisis, recovery, decline, prelude to dying, death, and grieving/legacy. Anybody starting to feel their age but still functioning like a young adult would be in the first one, and anybody familiar with aging parents or working at care of the elderly will immediately recognize the others. Talking briefly about each of them, Dennis makes it clear that where older people are concerned, there is no place for “fast medicine” with its efficiencies and disease-model approach.

Instead, he proposes careful listening, deferred decision-making, and generally “long slow cooking” through each of the “stations”, informed by a “circle of caring”: everybody closely involved in an old person’s life which may not necessarily be confined to or even include family members. At one point he advocates primary care doctors giving people their home phone numbers, as they used to do in the 1940s and 1950s. I can attest to the effectiveness of even that simple change at reassuring worried people and avoiding unnecessarily letting slip the dogs of technology.

Dennis McCullough is part of an organization of physicians doing community geriatrics in the United States. I hope to connect with them to get myself and some of my wonderful Canadian colleagues into an international dialogue. What’s absolutely clear is that without, in the beginning, any coordination or top-down ideology or direction, a couple of dozen programs have independently sprung up, all with the underlying idea that once frail, a human being needs and deserves loving personal individual healthcare. How can such a concept be wrong? How can it not be needed if it has spontaneously appeared in near-identical form in so many places?

Look for my book review of My Mother, Your Mother.

About John Sloan

John Sloan is a senior academic physician in the Department of Family Practice at the University of British Columbia, and has spent most of his 30 years' practice caring for the frail elderly in Vancouver. He is the author of "A Bitter Pill: How the Medical System is Failing the Elderly", published in 2009 by Greystone Books. His innovative primary care practice for the frail elderly has been adopted by Vancouver Coastal Health and is expanding. Dr. Sloan lectures throughout North America on care of the elderly.
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One Response to New England Programs II: Slow Medicine and Dr Dennis McCullough

  1. Marianna Rille says:

    Nice to see these positive comments. I was not able to make the evening presentation of the book, but I have ordered copies and plan to use the information personally as well as share copies with the GP’s in my life who I think will be receptive.

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