Bonaldi Antonio, Vernero Sandra
Recenti Prog Med. 2015 Feb;106(2):85-91. doi: 10.1701/1790.19492.
Italy's Slow Medicine was founded in 2011 as a movement aimed to promote processes of care based on appropriateness, but within a relation of listening, dialogue and decision sharing with the patient. The mission of Slow Medicine is synthetized by three key words: measured, because it acts with moderation, gradually and without waste; respectful, because it is careful in preserving the dignity and values of each person; and equitable, because it is committed to ensuring access to appropriate care for all. In a short time, the association spreads at national and international level, gathering the needs of change of a growing number of health professionals, patients and citizens, committed to manage health problems with a new cultural and methodological paradigm. Medicine is soaked with inappropriateness, wastes, conflicts of interest, and many clichés induce professionals and patients to consume more and more healthcare services in the illusion that it is always better doing more for improving health. Moreover, the dominant reductionist cultural model, on which the concept of health and disease is based today, considers man as a machine, investigated by a growing number of specialists, particularly interested in the pathophysiological mechanisms of diseases. The interest is mainly focused on technologies, while the person along with the relations with his/her family and the social environment are completely neglected. The systemic approach adopted by Slow Medicine, on the contrary, teaches us that health and disease are complex phenomena and the life of a person is more than the sum of the chemical reactions that occur in its cells. At different levels of complexity, in fact, new and unexpected properties appear, such as thinking, emotions, pleasure, health. These properties are not detectable in the individual elements and can only be studied using methods of analysis and knowledge belonging to other domains of knowledge, such as humanity sciences: philosophy, anthropology, psychology, ethics, art, etc. Operationally, Slow Medicine has launched the "Doing more does not mean doing better" campaign similar to "Choosing Wisely" in the United States, which aims to improve clinical appropriateness through the reduction of unnecessary tests and treatments: as first step, the specialty societies involved (30 by now) should indicate five tests or treatments commonly used in Italy's clinical practice that do not provide any benefit to most patients but may cause harm.
意大利的“慢医学”运动创立于2011年,其目标是推动基于适宜性的医疗过程,且这种过程是在与患者倾听、对话和共享决策的关系中进行的。“慢医学”的使命由三个关键词概括:适度,因为它行事适度、循序渐进且不浪费;尊重,因为它谨慎维护每个人的尊严和价值;公平,因为它致力于确保所有人都能获得适宜的医疗服务。在短时间内,该协会在国内和国际层面得到传播,汇聚了越来越多致力于以新的文化和方法范式管理健康问题的医疗专业人员、患者及公民的变革需求。医学充斥着不适当性、浪费、利益冲突,许多陈规陋习诱使专业人员和患者消费越来越多的医疗服务,误以为多做就总是对改善健康更有益。此外,当今健康与疾病概念所基于的占主导地位的还原论文化模式将人视为机器,由越来越多的专家进行研究,这些专家尤其关注疾病的病理生理机制。兴趣主要集中在技术上,而人及其与家人和社会环境的关系则完全被忽视。相反,“慢医学”所采用的系统方法告诉我们,健康和疾病是复杂现象,一个人的生命不仅仅是其细胞中发生的化学反应的总和。事实上,在不同的复杂层面会出现新的、意想不到的特性,如思维、情感、愉悦、健康。这些特性在单个元素中无法检测到,只能使用属于其他知识领域(如人文科学:哲学、人类学、心理学、伦理学、艺术等)的分析和知识方法来研究。在实际操作中,“慢医学”发起了类似于美国“明智选择”的“做得更多并不意味着做得更好”运动,旨在通过减少不必要的检查和治疗来提高临床适宜性:第一步,相关的专业学会(目前已达30个)应指出意大利临床实践中常用的五种对大多数患者没有任何益处但可能造成伤害的检查或治疗方法。