Victoria Sweet, MD, is an associate clinical professor of medicine at the University of California, San Francisco, and a prize-winning historian with a PhD in history. In her recent book, God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine, she argues for a new approach to medicine and health care that has been dubbed “slow medicine.”
Most of us know about the slow food movement. What’s slow medicine?
In a way, the slow medicine movement comes out of the slow food movement. Slow food came about to reclaim the old ways people used to think about food and eating, before industrialization. The slow medicine movement is an attempt to reclaim something about medicine and the relationship of doctor and patient that we’ve lost. A number of different people came up with the idea of slow medicine at around the same time, so there are different approaches and meanings. Dennis McCullough, a family physician and geriatrician at Dartmouth Medical School, has written a book about slow medicine, called My Mother, Your Mother: Embracing "Slow Medicine" which is based on his experience caring for his elderly mother. He discovered that the less you do in geriatric medicine, and the slower you go, the better for older patients. For him, slow medicine is really about taking your time. My experience of slow medicine, which is a little different, began with my discovery of Hildegard von Bingen, a 12th century abbess who was a mystic, a composer, and a theologian.
What does a 12th century mystic have to do with medicine?
Hildegard also wrote a book on medicine, which I discovered almost by accident. I’d gone to medical school. I’d done my residency. I understood modern medicine. But the more I practiced medicine, the more I realized there was something essential missing, a way of thinking about the relationship between doctor and patient. I’d looked into alternative medicine, homeopathy, Chinese medicine, Ayurvedic medicine. Somehow I didn’t connect with them. But when I discovered Hildegard von Bingen, I was hooked—so hooked that I wanted to read her in the original Latin. I took time off to pursue a PhD, focused on her work and writing.
How does her approach differ from modern medicine?
In Western medicine, we think mechanistically. Something is broken, we find out what it is and we try to repair it. That approach—thinking of the body as a machine and the doctor as a mechanic—came along in the 19th century, and it revolutionized medicine. Let’s call it fast medicine—the idea that you can diagnose the problem and fix it. And it has been amazing. All you have to do is look at what surgery can achieve or the way doctors treat trauma in an emergency department.
The notion of health and healing in Hildegard von Bingen’s writings is very different. It grows out of the agricultural world of the Middle Ages. The body is like a plant, and the physician is more like a gardener. That sounds pretty simple. But there’s a fundamental difference between a plant and a machine. A plant mostly can heal itself. If you wound a plant, it heals itself. If you break a car, it doesn’t. In the same way, there’s a fundamental difference between a doctor as mechanic and a doctor as gardener. If a plant is not doing well, you don’t start doing things to the plant. You ask yourself what it needs, or what’s in the way of its doing well. Is it getting enough sun? Is it getting too much sun? Does it need more water? Is it in the wrong place in the garden? We assume that it has the capacity to thrive. We just need to find out what it needs. That’s a very old, pre-modern way of thinking about the body. But I think it is very relevant today.
How did you incorporate these ideas into your own work as a physician?
I was fortunate. As I was exploring Hildegard’s teachings, I went to work at Laguna Honda Hospital in San Francisco. Laguna Honda was the original almshouse in the city, the place where sick people who had no money were cared for. It was built in 1926, a combination hospital, farm, boarding house. It even looks a little like a medieval monastery. Even today, Laguna Honda gets people who have fallen through every possible crack. They have multiple health problems, sometimes both physical and mental. Many of them are there for a long time. The prevailing model—that we could diagnose what’s wrong and fix it—mostly didn’t help there. And because of the very special nature of the place, we physicians were able to spend time with people. We could take the time to talk to patients, to examine them, to look over their old records. If I wanted to check in again, to examine someone, I could just walk over and see them. We had the time and space to have a real relationship with patients. And it made all the difference.
In what way?
Many of these patients had seen so many doctors, for so many problems, that they were on all kinds of medications. No one had taken the time to figure out what they really needed and what they didn’t need. We had people who were taking prostate medicine long after they’d had their prostates removed. Getting people off medications they didn’t need made them feel better. And by getting to know them, taking my time, I could begin to think about what they needed, what was in their way. We had many surprising successes. Patients who had been hospitalized for months, even years, were able to leave the hospital.
When is slow medicine appropriate?
There’s room for both slow medicine and fast medicine. If you’re injured in a car accident or you have a heart attack, believe me, you want fast medicine. You want a doctor to find out what’s wrong and fix it. But if you have a chronic condition, like diabetes, the slower approach may be much more helpful. Let me give you the example of patients with metabolic syndrome. They’re overweight, they have high blood pressure, high cholesterol, diabetes. If you meet these patients, they’re mostly miserable in my experience. They feel terrible about themselves. The doctor tells them to lose weight or get their blood sugar levels down—and lectures them when they don’t. The fast medicine approach wants to fix them. It envisions a future when they don’t have diabetes, or high blood pressure, when they’re not overweight or depressed. But right now that person is alive, breathing; that person has parts of their life that give them joy and pleasure. As a physician, I want to get to know that patient, and get to know about the things that are good, and then try to nourish those good things, the way you would nourish a plant.
Here’s a wonderful example. A physician in England had a group of women with metabolic syndrome, all of them heavy, hypertensive, terribly depressed. She arranged with a friend who was a dancer to offer them dance therapy—a chance to dance their depression, in a sense. They even made a lovely video about it called Finding Your Compass. The dance class gave the women what they needed, and it changed their health and their lives dramatically. That’s slow medicine.
What do doctors need in order to practice more slow medicine?
In a word, time. The only way you can practice really good medicine is if you have enough time. Period. We need our time back. Doctors and nurses alike. You can’t practice medicine in five minutes. You can’t short-circuit the process. Somehow, we need a revolution—we have to reclaim the time we need to practice medicine effectively. Medicine works best when it’s personal and face-to-face, when a doctor pays attention not only to the patient but also to what’s around the patient.People argue that we can’t afford to spend a lot of time. I’m convinced that taking the time to make the right diagnosis and choose the appropriate treatment will actually save time and money for the healthcare system.
What about slow medicine from a patient’s perspective? What can we do?
If you think about the idea of the body as a plant, you focus on the things that you need to be well. I think most people actually know a lot about what makes them happy, or what makes them sick. Part of the lesson of slow medicine is to pay attention to what you need, what will nourish you. As a culture, we’re obsessed with what people should or shouldn’t do. Don’t eat this; don’t eat that. Lose weight. Go to the gym three times a week. Slow medicine has a different focus, in my view. It’s more about finding space every day in your life to do the things that make you feel good. For a lot of people, that’s one of the most effective prescriptions we can offer.