MDM and Right Care: Reflections on the 2013 Lown Conference

By Aaron Leppin, MD (@aaronleppinmd)

“Do as much as possible for the patient, and as little as possible to the patient.”

This was the mantra of the 2013 Lown Conference and the personal motto of Dr. Bernard Lown, a beloved clinician and activist and winner of the Nobel Peace Prize.

As a representative of the International Minimally Disruptive Medicine (MDM) Workgroup, I had the privilege of attending the 3-day conference in Boston in early December. Hosted by the Lown Institute, it brought together like-minded clinicians, researchers, patients, journalists, and patient advocates from around the world to consider some of the most fundamental problems in medicine and healthcare today—everything from the patient-centeredness of clinical encounters to the effects of policy and medical education on care activities. In many ways, the conference served as a “revival” meeting for those of us that believe healthcare should be delivered in a more effective, supportive, and context-sensitive manner.

Although the Institute (and MDM for that matter) places special emphasis on raising awareness about waste in healthcare and in developing strategies to avoid the perils of overtreatment, the Conference itself was much broader in scope. Indeed, both the Institute and MDM recognize the need for care to be “right.” In some cases, this may mean healthcare should be not only minimally disruptive but also “maximally supportive.”

For example, consider these words distributed to conference attendees by the Lown Institute:

“We envision a more just and compassionate world where health and health care are rights; where physicians serve as healers and as advocates for those who are vulnerable and most in need of care; where patients receive the medical services they need and are safe from unnecessary treatment and harm; and where health care exists for the benefit of patients, communities and nations.”

Overall, the commonality between the visions for healthcare of the Lown Institute and what we are trying to promote in Minimally Disruptive Medicine are unmistakable.

The first day of the conference was devoted to identifying “right care” through the optimization of the patient-clinician dialogue. From an MDM perspective, these discussions should include an assessment of patient capacity, context, and goals for life and health. In MDM, we promote the use of shared decision making and the establishment of a strong and meaningful patient-clinician partnership to help achieve this end. Dr. Lown, in his book, The Lost Art of Healing, also promotes the importance of the patient-clinician bond.

The second day of the conference focused on achieving right care as a society. It touched on everything from the moral and spiritual dimensions of overuse to practical strategies for engaging stakeholders in change. As most of my research related to MDM focuses specifically on patient-level interventions, I found many of these broader discussions to be quite enlightening and challenging.

The final day consisted of a number of concurrently conducted working group sessions. I attended one devoted to the development of a research agenda where I learned a lot about the work being done to characterize the problem of overuse in healthcare. Other sessions focused on Choosing Wisely (a component of the MDM toolkit), medical education, and public engagement, for example.

Overall, the Conference was a fabulous experience and the Lown Institute should be commended for the work they are doing. In my view, supporters of MDM should be (and in many ways already are) supporters of Lown.

Please consider joining myself in signing the Right Care Declaration and showing your support for a “better, more affordable, more compassionate health care system.” This can be quickly done at www.rightcaredeclaration.org

Also consider following the Institute on Twitter at @lowninstitute

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