Granted a capacious amount of time and freedom with her severely ill patients (many of them drug addicts, schizophrenics, or elderly and with few resources), Sweet is able to make diagnoses that her patients’ previous doctors missed. Relying on close observation to help her understand what’s really going on, she weans them from an average of 20 medications to six or seven. She finds that discarded medical practices—for example, manipulating the lymphatic system with an old-fashioned medical girdle—may have more to offer than contemporary interventions do. In one heartbreaking case, she realizes that an elderly patient is not suffering from Alzheimer’s following a hip surgery, as doctors at the woman’s former hospital concluded—a diagnosis that led to antipsychotic medicines, her removal from her own home, and her separation from her mentally disabled daughter. Rather, she is in pain: the hip had slid out of place, and no one responsible for her follow-up care had noticed.
Laguna Honda—where meals were served in sunlit rooms, and gardening and good company allowed hopeless cases to make seemingly miraculous recoveries—seems out of another era. Indeed, in 2010, after years of construction and renovations, it became a “modern” facility. But “slow medicine,” as Sweet trenchantly argues, isn’t an outmoded, soulful indulgence. It might actually be a form of efficiency: more-accurate diagnoses and effective low-tech treatments help the system save money, and result in fewer malpractice suits.
Atul Gawande suggests much the same thing in Being Mortal, arguing that fast, solution-oriented care—particularly in the last year of life, which accounts for an estimated one-quarter of Medicare expenditures—has, in missing the broader picture, led to a great deal of “callousness, inhumanity, and extraordinary suffering.” In The Doctor Crisis, which issues a biting call for a physician-led revolution in medicine, Jack Cochran, too, appreciates a core tenet of the slow-medicine spirit: fulfilled doctors make for more-satisfied patients. Tackling the problems of Kaiser Permanente’s Colorado medical group, he took the counterintuitive step of demoting “patient-centered care” as a goal, and elevated “preservation and enhancement of career” for doctors to first place. He restored to them the sense that their work is, as Barron Lerner’s old-fashioned father put it, a “rare privilege” to be pursued with a sense of responsibility, rather than harried accountability.
Medicine today values intervention far more than it values care. Gawande writes that for a clinician, “nothing is more threatening to who you think you are than a patient with a problem you cannot solve.” The result is that all too often, “medicine fails the people it is supposed to help.” The old doctor-knows-best ethos was profoundly flawed. But it was rooted in an ethic of care for the whole person, perhaps because physicians, less pressed for time, knew their patients better. Danielle Ofri notes that it was the paternalistic old doctors, still hanging around her medical school wearing “starched shirts [and] conservative ties,” who taught her the art of respecting her patients’ individuality: “For them, approaching the bedside of a patient was a sacred act.” One day she had a class with an intimidating cardiothoracic surgeon. To her surprise, he was as tender toward his wards as he was gruff toward his students, who, he insisted, should always seat themselves at the level of the patient or lower. “They are the ones who are sick,” he emphasized, “and they are the ones running this interview, not you.”