Slow Medicine: The Way to Health

Book Title: Slow Medicine: The Way to Health

Book Author: Victoria Sweet

Publication Information: New York, Riverhead Books, 2017, 304 pp., $27, hardcover

Medicine appears to have reached a point where the majority of providers are frustrated with providing health care. For some, it is the lack of control over patient care decisions, for others it is the depersonalization via the electronic health record, and for many it is seeing patients at an unmanageable pace. For me, it is all three. For Victoria Sweet, it was all of these and more. She described her professional demise in her first book, God’s Hotel.¹ Her latest book, Slow Medicine, acts as a prequel and an epilogue. One does not have to read God’s Hotel to appreciate the messages in this book. In fact, much of her critique of the current system will be very familiar to readers. So then why read the book?

Dr Sweet is a gifted writer. Throughout the first three-quarters of this book, she uses personal stories from medical school, residency, and her early career to make her points. Her approach is not one of complaints about our current system with a nod to the glory days of yesteryear. Rather, she describes the influences in her life that taught her how to practice thoughtful and compassionate medicine. From Dr Greg she learned “with any disease, about a third [of patients] get better, a third get worse, and a third stay the same—all we do is change who does what.” From Dr Miller she learned that sometimes we have to go so slow with weaning a medicine so as to trick the body into barely noticing the change.

Dr Sweet’s life and medical trajectory are not of the standard variety. She began in psychiatry and switched to medicine, and has interests in medieval medicine and anthropology. She has practiced in small towns, with migrant farmers, and right out of medical school before returning to residency. This affords her many tales, and she knows how to tell a story. We follow along as she makes her first diagnosis by looking back through old records and finding the one abnormal result that was overlooked. She writes in awe of the nurse who drove to a patient’s home after the emergency room sent him home twice and drove him back herself for an admission, thus saving his life. And there are many more.

If you have read God’s Hotel, this book enters into familiar territory toward the end. We are reminded of the example of that once-great caring center, San Francisco’s Laguna Honda Hospital. That evolution of Laguna Honda is a microcosm of the medical politics and overemphasis on quality that overlook the individual and focus on ticking the right boxes at the expense of truly helping a patient.

Slow medicine, Sweet writes, is a way of understanding medicine and “a way of seeing, doing, and being.” In other words, finding a way within our fast-paced system. Of course there are times for fast medicine (eg, emergency care), but we need to step back and ask ourselves, like her medieval heroes did—what is getting in the way of the patient’s own ability to heal. This also means avoiding overtesting and overdiagnosis—it means practicing common sense medicine. She celebrates the physical exam, listening, and enjoying the story. While there are not specific answers to our burnout-provoking system, there are suggestions for finding what you enjoy and clinging to that.

This book is an important read for medical professionals at all levels of their training and career. For students and residents, the lessons the author learned during her formative years will help vaccinate them against becoming disgruntled within our current system. Sweet writes about who influenced her, and learners may be motivated to find mentors based on this. She celebrates medicine as a culture, as carrying a “special weight.” For practicing physicians, this book will remind them what they love about this noble profession and encourage them to push back against moral injuries being hoisted upon us. Sadly, Dr Sweet is no longer practicing (spoiler alert), but her lessons are inspiring nevertheless, and they are specific enough that those on the brink of giving up can look toward the light and reinvent themselves with a slow medicine framework. I speak with confidence about her influence as I have made such changes in my own care giving based on her example. This book, and others like it, should act as our talisman for a new world order in US medical care.