SLOW MEDICINE
The Way to Healing
By Victoria Sweet
289 pp. Riverhead Books. $27.
Doctors today often complain of working in an occupational black hole in which patient encounters are compressed into smaller and smaller space and time. You can do a passable job in a 10-minute visit, they say, but it is impossible to appreciate the subtleties of patient care when you are rushing.
Enter “Slow Medicine: The Way to Healing,” a wonderful new memoir by Dr. Victoria Sweet. The term “slow medicine” has different interpretations. For some it means spending more time with patients. For others it means taking the time to understand evidence so as to avoid overdiagnosis and overtreatment. For Sweet, it means “stepping back and seeing the patient in the context of his environment,” and providing medical care that is “slow, methodical and step-by-step.”
At the beginning of her book, she relates how her 93-year-old father was mistreated after being hospitalized for a seizure. He is put in 4-point restraints and sedated. Bloody urine drains from his bladder because it has been injured by a catheter insertion. Worse, his rushed doctors don’t know that this isn’t his first seizure but rather the latest in a long line that can be managed at home.
The steamroller of inpatient care takes over. Every day Sweet’s father sees a different doctor. He isn’t allowed to eat or get out of bed because he is on tranquilizers. He becomes septic. His symptoms are misdiagnosed as a stroke. Doctors eventually prepare to insert a feeding tube into his stomach because he cannot swallow. Sweet and her sisters get him out of the hospital just in time. When he gets home, he has a steak and a beer.
Sweet writes, “If I, as a physician, couldn’t get appropriate care for a family member in a lovely community hospital with well-trained staff — who could?”
She yearns for a different kind of medical care — one that is not “a commodity, bought and sold on Wall Street.”
Sweet’s book pivots from this point into a memoir of her education as a doctor. In often lyrical stories, she recognizes ailments that elude her colleagues. After poring through charts to diagnose a patient with multiple myeloma, a blood cancer masquerading as schizophrenia, she writes that it is proof that being rushed in medicine is not only wasteful but dangerous.
Sweet maintains a healthy respect for modern medicine, however. Dialysis, antibiotics and intensive care units save lives. She knows their power but their limitations, too, and this girds her subtle and insightful commentary.
Sweet is an unlikely advocate for a kind of soft paternalism. For example, if not for Kathy, a determined nurse who browbeats a man with a tear in his aorta to return to the emergency room that has twice misdiagnosed him, the patient surely would have died. “Kathy showed me,” she writes, “that the best doctor diagnoses, prescribes, drives the patient to the ER, and then makes sure he gets the right treatment. By force, if necessary.”
Such hardheadedness, in Sweet’s view, is also needed when patients insist on aggressive, possibly futile, end-of-life treatment. “ ‘Patient autonomy’ goes only so far,” she explains. “No patient, no family, can know what they are saying when they say, Do everything. Being a doctor means seeing things clearly, explaining things clearly, but in the end, if necessary, it means saying no.”
One of the most compelling stories in the book is about Joey, a 3-year-old who is diagnosed with terminal lung disease after a near-drowning but against the odds makes it off the ventilator and out of the hospital. Sweet interprets Joey’s recovery in part as a victory for prayer. “Prayer worked,” she writes, “at least that once and maybe sometimes and maybe always.” I would see it differently: Joey was saved because a lung specialist slowly decreased airway pressure and tidal volume over several weeks in a patient with acute respiratory distress syndrome. And, as Sweet points out, it was slow medicine that allowed that doctor to make the proper adjustments.
Perhaps Sweet’s most depressing conclusion is that Joey would have died today. His doctors “would have been too busy entering health care data” that was required “according to all the mandated protocols.” Physicians would do well to learn this most important lesson about caring for patients from Sweet’s book: “Establishing the correct diagnoses and then getting them off all those unnecessary medications, with their side effects and adverse reactions, took a lot of time, but in the long run it saved way more money than it cost. It was slower but it was better.”
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