Is the body a machine — the brain a computer, the heart a pump? Is the doctor’s job to find what’s broken and fix it? (That’s fast medicine.)
Or is the doctor a gardener, fussing around patients to discover what is in the way of being healthy and changing what can be changed, removing what needs to be removed, so the body can heal itself? (That’s slow medicine.)
That is the question that Victoria Sweet poses in her second book on the inner life of doctoring, Slow Medicine.
Given the title of the book, one might assume that the answer, for Sweet, is obvious: Minimize interference and medicines, and allow time for the body to heal itself and restore to balance the “mismatch between the inner body and the outer world.”
But not so fast. Sweet was educated in and is a true believer of fast medicine, our modern healthcare system in all its drug- and scalpel-oriented glory. So how does she reconcile the two? Fast medicine is needed for the miracles created in acute care — heart attack damage averted, severed limbs reconnected. But recovery and daily health are the realm of slow.
Don’t worry. I haven’t spoiled the book for you, because the pleasure of reading Sweet is in the storytelling.
Fast medicine vs. slow medicine: It’s a discussion we all need to have with our families, our healthcare providers and our health insurers.
Stories like the doctor who told Sweet, “We doctors think we’re so important… but the way it works is that in any disease about a third of the patients get better, a third get worse, and a third stay the same — all we do is change who does what.”
These words resonated years later for Sweet when caring for Mrs. Persily, an aged dementia patient. Pneumonia had taken hold, called “the old man’s friend” in the pre-antibiotic era because untreated it leads to a rapid, relatively easy death. Because Mrs. Persily was in frail health, she no longer recognized her family and couldn’t dress, walk or feed herself.
In consultation with the family, Sweet left orders for Mrs. Persily not to be treated with antibiotics, but to let nature take its course. Without antibiotics, death was expected within a day or two. But unexpectedly, Mrs. Persily’s immune system fought off the pneumonia and within a few days she was healthy and able to be fed again.
Sweet’s first book, God’s Hotel, was a lyrical reminiscence of Sweet’s time working at a charity hospital where patients stayed for years healing. Slow Medicine, however, is both a defense of fast medicine and an indictment of our present hospital-based medical system. Both halves of fast and slow medicine, she implies in her new book, are needed for complete care.
Following the slow medicine theme that is gaining attention and (hopefully) some traction among those interested in medicine, Rich Joseph, MD, published an op-ed piece in The New York Times last month. He wrote about being an intern and tending to the famous Dr. Bernard Lown. Of Lown’s many accomplishments (Nobel Peace Prize among them), his work in changing the medical system has been the common thread.
Joseph reports Lown complaining, “The hospital, he lamented, is more like a factory —‘it tests every ache and treats every laboratory abnormality, but it does little to heal its patients.’”
Joseph draws the contrast between treatment vs. healing similar to Sweet’s fast vs. slow medicine. It’s a discussion we all need to have with our families, our healthcare providers and our health insurers, who too often insure treatment but don’t compensate doctors for healing.