I’m one of the biggest consumers of the new faddish approach to medicine – the idea that what will “fix” medicine is right around the corner. Last month, I was mindfully eating raisins and sitting at the bedside of my patients. A few weeks ago, I was streamlining an approach to effective documentation. And yesterday, I became a convert to the concept of “slow medicine” – which uprooted all of my prior theories. I finished Victoria Sweet’s book “God’s Hotel,” about a hospital in California rooted in principles of pre-modern medicine: hospitality, community, and vitality. Dr. Sweet discusses the concept of slow medicine, an approach that emphasizes taking thorough histories, understanding environmental factors leading to patients’ ill health, and following patients over time. She talks fondly of working at Laguna Honda Hospital in the 1980’s, in a place where patients gardened outside, chickens roamed the wards, and live-in nuns and priests knew the patients deeply.
Slow medicine is one of many proposed solutions about what will “fix” the American medical system, including: integrated medicine, mindfulness, and patient-centered care. Each proposed humanistic remedy has its technological antidote, and their group of proponents: those for checklists, cost-conscious care, and the genomic revolution. It is not hyperbole to say that each group lives in different societies. In fact, it is literal: there is a society for nearly every theory these days (Humanism society, Society for Hospital Medicine, etc.). On one side, the technologists argue that it is the system that is broken; the computerized records are too slow, the medical factory too inefficient. The humanists argue that it is we who are broken.
The technologists and humanists share the same myths: belief in progress, ideas, and the concept that more is better. First, there is the American mythology of progress – the belief that the future will inevitably improve upon the past. The second, less obvious myth is that ideas have a force of their own, beyond that humans think them up and carry them out. If medicine would just embrace “X,” what a difference it would make! This makes clinical training confusing for the undifferentiated mind – “so, I’m supposed to mindfully take a history, while using a checklist and being cost-conscious?” The final myth, again quite American, is that more is better.
The concept of slow medicine dispels all three myths of the humanists and technologists. Practicing slow medicine will likely not “fix” the cost problem in healthcare. Yes, it is an idea, but not one easily commodified into new Institutes or Centers of Excellence. The idea of practicing medicine slowly is one rooted in individuals, out of lived experience with patients. Finally, slow medicine embraces the concept that sometimes “less” is better.
At 3am the other night, I tried it. I was tired of documenting efficiently, being mindful, and screening my 23 year-old patient for her exact pack-year history of smoking. I pulled up a chair and we talked. She came in with a large lung clot, and an unusual history of bleeding disorder. We talked about her chance of having a hereditary bleeding problem, her father’s 16 children, her identity as African, Chinese and Cape-Verdean. We talked about her three kids, and extensively about her best options for birth control. Shortly after, we talked about her love for women, rending moot my fifteen-minute birth control speech. We talked of her love for Dr. H, the mild-mannered gynecologist who diagnosed her bleeding disorder; her trust in him and commitment to following any of his recommendations. Thirty minutes later, I got up to leave. With no checklist or tight agenda, I found I had covered quite a few practical topics: her risk factors for clots and what would help her be compliant with blood thinners for the next six months. For me, that was slow medicine, and in tune with my own core personality; a little tangential, inquisitive, and possibly a bit too personal.
The highest praise for the concept of slow medicine may be that it is fun and comes with no added paperwork. All it requires is a chair, curiosity, and the capacity for reflection. One of Dr. Sweet’s most compelling adages is: it is the good doctor who prescribes the right medicine, the great doctor who walks the patient to the pharmacy, and the best doctor who watches the patient take their medicine. Like slow medicine, it may not be efficient, but it sure makes sense.
Image courtesy of @SlowMedicine