Slow Medicine and Choosing Wisely: a synergistic alliance

Choosing Wisely® is an initiative of the American Board of Internal Medicine Foundation to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices. Choosing Wisely campaigns are now active and present in 25 countries around the world, on five continents. Italy is the only country where a Choosing Wisely campaign was launched, and it is currently steered by a Nationwide association (Slow Medicine), creating a synergistic alliance. The Slow Medicine Association was founded in 2011 when a group of health professionals and citizens shared a new paradigm of values, methodology, and interventions and decided to establish an association with the mission of working for a health system driven by ethics and quality principles. Three keywords summarize the philosophy of Slow Medicine: measured because it acts with moderation, gradualness, and without waste; respectful because it is attentive to the dignity of individuals recognizing their values; and equitable because it is committed to ensuring appropriate care based on the best available evidence. Slow Medicine allowed the spread of Choosing Wisely in Italy involving several professional societies and participating at the National meetings of the Societies as well as numerous other meetings, in which the mission of the Association is combined with the principle of the ‘do not’ recommendations. Numerous other initiatives were carried out, and new projects were planned in synergy with Choosing Wisely.

Slow medicine: a philosophical conception for a humanized geriatric practice

Expansion of the concept of health, care fragmentation, and technology overvaluation have fostered discussions about the limitations of the biomedical model. The post-COVID-19 era can be one of the largest and best windows of opportunity for implementation of interventions aimed at promoting health equity, particularly in geriatrics. The mission of Slow Medicine can be summarized in three keywords: measured, because it acts with moderation, gradually and without waste; respectful, because it seeks to preserve the dignity and values of each person; and equitable, because it is committed to ensuring access to appropriate care for all. Operationally, the Slow Medicine movement is known internationally for the “Doing more does not mean doing better” campaign, whose objective is essentially to reflect upon and try to engage physicians in reflective practices to avoid the overuse of medical resources, both diagnostically and therapeutically. In this article, we present a brief historical summary and the principles that guide the praxis of the Slow Medicine movement, and invite the reader to reflect on a “geriatrics without haste.”

Choosing Wisely, the reasons for its success

The philosophy and the history of the International Choosing Wisely movement, launched in the U.S. in 2012, are described. It grew and spread beyond what it was anticipated at the beginning because there is a rising concern of the medical community regarding the appropriate use of procedures and treatments placed into the market before an adequate evaluation of risks and benefits. Not only healthcare providers, but also patients, citizens and politicians, are becoming aware of the consequences of inappropriate decisions and behaviors since inappropriateness has economic (waste of resources), clinical (risks), but also ethical implications. In Italy the movement was launched and still is coordinated by the Slow Medicine organization, that created the campaign Doing more does not mean doing better – Choosing Wisely Italy, which aimed to improve clinical appropriateness through the reduction of unnecessary tests and treatments and the dialogue between physicians and patients. Currently, 44 societies of physicians, nurses, pharmacists and physiotherapists identified 230 recommendations about tests, treatments and procedures commonly used in Italy’s clinical practice that do not provide any benefit to most patients but may cause harm.