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  • Writer's pictureJonathan Burns

Fast is Slow



There’s a saying in pain management: “Fast is slow.” I first heard it when I was learning to perform a spinal cord stimulator trial. The procedure involves placing catheters in a patient’s posterior epidural space in their spine. The catheters have electrodes in them that stimulate the nerves and either produce a pleasant tingling sensation that distracts the patient from their chronic back and leg pain or blocks their pain. The procedure takes some finesse, as the needle needs to be at just the right angle and the entry point for the catheter has to be at just the right spot to gain suitable access to the epidural space. On top of that, the advancement of the catheter has to be done gradually and with considerable attention so as to avoid any adverse events or problems that may lead to a poor outcome.

The emphasis on going slow to get the procedure right was not lost on me. If the catheters went in at too steep an approach, you could pierce the dura and cause a tremendous headache and effectively end the procedure before it started. Similarly, if the catheters went off to one side or another, nerve or vascular damage could result, leading to serious complications for the patient. The placement of the catheters needs to be smooth, not only for safe optimal placement but also because the patient usually tolerates it much better. This takes practice and improvement in technique until it becomes straightforward.

Going slowly while learning a new skill makes sense, as you are still figuring out the nuances of the procedure and making sure you are doing it right. What might be counterintuitive is the idea of continuing to proceed slowly in the effort of going quickly, even after you have considerable experience in performing the procedure. And perhaps “slowly” is not quite the correct term for proceeding “smoothly.” Slowly implies deliberate, often painstaking, effort to not go too fast. Smoothness is something else entirely. Smoothness really means every step of the procedure is done very well and done the first time without rushing so that you can move on to the next step in the same smooth process until the procedure is complete.

I have found striving to go slowly, or more accurately smoothly, in other aspects of life has been useful. Instead of reacting to upsetting news or harmful actions of others with either a knee-jerk response or rushing to act quickly to stop whatever problems arise, if I can pace my reaction so I am in control of each step in my reaction, I find things go better for me and my team. This requires stepping back, as many effective leaders are able to do, and look at the big picture and find what the actual end result you are trying to achieve actually is. Then take the necessary steps in a calm manner to slowly approach that goal. In a smooth way, of course.

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