One Doctor's Mission To Bring 'Slow Medicine' Approach To Caring For Aging Parents

MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. The end-of-life for an elderly relative can be can be a crisis time for family. According to a new approach in geriatric, it does not have to be. Slow medicine is an idea of providing the right kind of care at the right time for people chronic illness. End-of-life decisions without panic. Dr. Dennis McCullough is my guest. He advocates for the concept of slow medicine and is the author of the book My Mother, Your Mother. Helen McNeal, the Executive Director of the California State University Institute for Palliative Care at State San Marcos, is also here. Helen thank you for coming in. It seems that chronic care and end-of-life care has become much more complicated in recent years, why? DENNIS MCCULLOUGH: There's so much more that can be done for people. People end up as they are older with more problems. Families have to cope with the complexity of that. There's a good side of it. High-tech medicine offers a great deal, but we have lost capacity to make more measured judgments and talk with people and prepare them for the more difficult situations that they may face. MAUREEN CAVANAUGH: So often we hear families struggling with what choices they should make for elderly parents. Are the voices of parents getting lost in these decisions? DENNIS MCCULOUGH: You are at the very center of it. I wrote my book because I wanted to help represent the voices of older people who I have cared for. It's not that families are to do all of the decision-making here. Older people ñ including us ñ will have a piece of that decision-making. Older people do not have the energy to write from the center of their lives as they are older. When I can find any old person who's writing something like poetry are doing something creative, I love that. It incorporates a different kind of understanding. I wrote my book with the advice and help and editing of my older patients who said tell my children this. MAUREEN CAVANAUGH: What are some of the things they want their children to know? DENNIS MCCULOUGH: Their friends may understand them better than their children do. You have not spent enough time with us to realize, or have us trust you fully in making decisions that society thinks you have to make for us. The whole issue of relationship, and when you start to restore a healthy relationship within the family. That is at the center of the book, about rebuilding families for this stage of life. MAUREEN CAVANAUGH: What is slow medicine? DENNIS MCCULOUGH: Slow, it's a metaphor that I tried to use that older people understand instantly. If you say ñ what it means is not being rushed so much ñ being able to negotiate when you're giving up parts of your driving, when you may change locations and go to live near your children. When you are going to be ready to make healthcare decisions, slowing it down. As a fundamental principle it's very central to what older people want. MAUREEN CAVANAUGH: A lot of people probably know that usually these decisions are made by a crisis. DENNIS MCCULOUGH: Precisely. Slow medicine is about cutting off crisis. When it is done well it is shown with data that you can cut down on emergency room hospitalizations. These people do not want this. An older person can be saved a crisis. It is an enormous gift. When have a crisis when you're older it's tough, each time it gets tougher. Every time you have a crisis you are the causing quality of life to decline. MAUREEN CAVANAUGH: Helen McNeal, what is the relationship between slow medicine and palliative care? HELEN MCNEAL: They have common roots. They both focus on needs, quality of life, patient and family, and holistic care. Not just looking at medicine but the whole care of the person. One of the challenges that we face in the world of palliative care is having people make informed decisions ñ and make them early ñ so they can have quality of life and communicate them. What is exciting with slow medicine is that there is a natural flow between palliative an slow medicine. Slow medicine focuses on elders. Palliative care focuses on anyone with a serious or chronic illness. There's a natural flow between the two. MAUREEN CAVANAUGH: I think people think of palliative care as the last alternative. Is that the way it should be? HELEN MCNEAL: Absolutely not. Palliative care goes hand in hand with treatment. It's appropriate from the moment you are diagnosed with a chronic illness all the way through death and beyond. People confuse it with end-of-life care and hospice. That is the biggest educational piece we have with the public, to get people understand that it is appropriate from diagnosis onward. MAUREEN CAVANAUGH: I want to pursue this further. There is a conception about palliative care. Easing pain and making the conditions of the patient as good as possible. Without any kind of distress. Not actually taking any steps to cure an illness. Is that incorrect? HELEN MCNEAL: It is hand-in-hand with. When people ñ we know from the research is that when people get palliative care, attention to what is important, attention to the psychological and spiritual issues, they live longer. It's not about not caring for, it's about enhancing quality of life and improving longevity. MAUREEN CAVANAUGH: Dr. McCullough after years of treating patients you get a better understanding of process of care by caring for your own mother. That is where your book comes in, My Mother, Your Mother. What did that teach you? DENNIS MCCULOUGH: It taught me that is very difficult for any healthcare professional to translate their own experience into the personal setting. It also taught me patience. It taught me how I had to listen more carefully to my mother than I ever had before, had to understand her context. Her friends, where she lived, what was available changing interests, all of those things in a way that I did not fully appreciate was so important for elder care. In the past. MAUREEN CAVANAUGH: How does that translate to people that need to help the aging family member? DENNIS MCCULOUGH: I will give you the toughest exercise. I call it the 72 hour visit. You go one child at a time ñ if there are more than one ñ and spend 72 consecutive hours with your parent being with them, no telephone or computer, none of your connections that you usually have. Get to know their friends, talk with them and get perspective on what is going on, but experience 72 hours of the parents life and let conversations unfold. It's a tough undertaking, but I think that for every adult child that is that starting point for understanding the parent. MAUREEN CAVANAUGH: You think you know your parents, but you don't. DENNIS MCCULOUGH: You think to an extent that parents have been pigeonholed to take the things that you are the daughter who cried, so don't want her to make decisions for you. You think the son has been a star in every fashion, so he is going to be a star as the guide, if you're not able to make decisions. It may turn out that they have a different understanding of their children than their children have of them. I also thrown plug for grandchildren. And grandchildren can sometimes break barriers of communication that cannot just happen around one generation. There is an adolescent conflict that comes up with your parents. The have tackled the issue of siblings. How to regroup with them if you're going to be successful. This foundation that really lays the basis for proceeding down the path with so many uncertainties. MAUREEN CAVANAUGH: See, that is a very good insight. I never would've thought that. I'm going to ask you how the idea of split medicine changes the idea of how people should make medical decisions. Other times when these yearly tests should come to an end? DENNIS MCCULOUGH: I've been trying to promote the approach called Never Alone. None of us should go to a doctor's appointment alone. When you look at studies done about retention of information, what a physician thinks he has communicated with you is so different from what you actually find when you survey that person leaving the room. If you take that conversation with two people listening, because beyond the 15 or 20 minutes and there's a give and take that enriches communication. That is the starting point. That becomes the basis for beginning to recognize that many things that are recommended for older people have limited value as you get older. A good example would be preventative use of lipid production medication for people who have no significant disease of the heart. That falls down when possible side effects begin for all of these medicines to increase the get older. And now with my mom, we thought she was just getting old because her naps are getting longer, but when we talk about changing beta blocker medication for blood pressure, which she been on for many years, she woke up. A beta blocker is a sedative. MAUREEN CAVANAUGH: I'm wondering Helen, as you look towards the future, palliative care and slow medicine can be part of more of our lives. We captured the challenge of dealing with more older people in our society, how do you see this working to change the healthcare system? HELEN MCNEAL: What I think our healthcare system is in a time of change. Palliative care and slow medicine are right at the heart of that. The reason for that is because we are recognizing ñ as baby boomers ñ we like quality of life. We also recognize that we cannot afford the health care system that puts 50% of the investment of the last year for life, which may be futile care. We need to look at how we enhance people's quality of life and learn from research when we do. Bring palliative care together with more traditional Western medicine, to meet disease modifying treatments, people live longer, make better decisions, and most importantly the cost is less. It's important that people are happier and living longer. And by the way, we're saving the healthcare system money. That is a combination that is a winner in today's healthcare system. MAUREEN CAVANAUGH: Having gone through such debate over the affordable care act, and death panels where it sounded as if making decisions about long-term care, or a doctor sitting with you and talking the options, would be tantamount to withholding care to older people. I wonder if you still come up against that notion when you're talking through these kind of things? DENNIS MCCULOUGH: Occasionally people bring that up, more in the beginning. People are beginning to understand that slow medicine is an approach that empowers older people to direct along with the guidance of family and friends on their own care. The more you can do this early, the less you're going to feel that you are not empowered. Sometimes that may be going to intensive care, other times it may be turning down chemotherapy. It is highly differentiated, crafted for every individual. There's nothing about a policy here that says a certain age or certain problems should not be able to have the have access to care. That is not fair, that is not American, it will not happen. MAUREEN CAVANAUGH: Let me tell everyone how they can hear more about this. There are two free public lectures this week. One in North County, tomorrow at 6PM at California State University San Marcos. Thursday in La Jolla Scripps Memorial Hospital at 6 PM. Also, reservations are required. You can find a more at our website KPBS.org. I've been speaking with Dr. Dennis McCullough author of the book My Mother, Your Mother. And Helen McNeal of California State University Institute for Palliative Care at Cal San Marcos. Thank you both. [[NEW SEGMENT]]