Book Review

Take the Slow Boat To Healing

Peter Boland
Victoria Sweet, MD

Slow Medicine is the deeply personal account of Victoria Sweet’s journey through medical school, internship, residency, and a series of unconventional career choices. In addition to her medical degree from University of California–Irvine Medical School and training at Kaiser Permanente, Sweet earned a Ph.D. in medical history, studying medieval medicine and Hildegard of Bingen, a 12th century mystic and medical practitioner.

Sweet, an associate clinical professor at University of California–San Francisco, uses dozens of poignant patient stories as a way of showing where “fast” medicine that emphasizes medication and technology falls short.

One of Sweet’s early mentors said the way medicine works in any disease state, “about a third of the patients get better, a third get worse, and a third stay the same—all we have to do is change who does what.” She found that to be true. With this advice as a touchstone, Sweet began to pay attention to whether conventional medical treatment actually changed this distribution. Often she found that it simply changed who does what. New treatments decreased the problem for which they were prescribed but new problems often took their place. The ratio of those who got better, got worse, or stayed the same did not change.

Sweet doesn’t reject contemporary medicine. Fast and slow medicine can coexist, she argues, so a kind of “wholeness” emerges. She sees a need for striking a balance between them that depends on the individual characteristics and needs of individual patients. Figuring those out requires slowing down—way, way down at times. Sweet says she begins a typical patient encounter by sitting on their hospital bed and just talking face-to-face rather than beginning with the information in their medical chart. She starts with a simple question, “How are you doing today?” and then observes her patient. Listening and observation conveys a unique story that does not necessarily show up in an electronic medical record.

The strength of Slow Medicine is the author’s ability to pull the audience into a different reality, one that harkens back to an earlier era of one-on-one medicine, when physicians and patients commonly shared a bond of trust and familiarity. That era has faded with the emergence of systems of care and performance targets.

Every patient must be fully seen and felt. That is a central theme of Sweet’s slow medicine, and it serves as a reminder of how far American health care has swung in the other direction where patients tend to be viewed in the narrowest of terms. Slow medicine, as Sweet describes it, is the antidote to the loss of craft and caring from medicine as it becomes more and more of a commodity.

Is this nostalgic pining for a bygone era and a formula for stasis? Sweet doesn’t think so. She believes that the flashy appeal of fast medicine will wear off because of the toll it takes: wrong diagnoses, misguided treatment, wasted expense. Slow medicine will gradually infiltrate hospital care again, she believes, so that doctors will have enough time to find out what’s really wrong with a patient, and patients have enough time to heal. It’s fair to ask, though, how long it will take for the slow medicine way of doing things to seep in.

Sweet calls on physicians to resist the pressures of health care today and to incorporate the sensibilities of the earlier age of slow medicine. Hers is an important message that needs to be heard, regardless of how many choose to heed it.

Peter Boland of Boland Healthcare is a health care consultant in Berkeley, Calif., and a member of Managed Care’s editorial advisory board.