The trouble with reading books by doctors like Otis Brawley, Atul Gawande, and Victoria Sweet is that you want them to be your doctor. The lesson, ultimately, is that you have to find your Otis, Atul, or Victoria where you live, yet there aren’t enough Otiss, Atuls, and Victorias to go around.
Slow Medicine is a memoir tracing Sweet’s unique development as a doctor, scholar, and muse. One resource physician authors have that civilian authors who write about medical matters don’t is a deep store of stories in the form of patient vignettes, whereas civilians drawing on their own experiences have—hopefully—only a few. Sweet opens Slow Medicine with possibly the most horrific story I’ve encountered throughout the approximately one-hundred books I’ve read on end-of-life and medical matters. She describes her father’s recent hospitalization that almost became terminal—not because he was but because the records were wrong and no one involved would or could treat the actual problem. Instead they treated a false problem, and that treatment was inexorably killing Sweet’s dad. The year’s not cited but Sweet describes her peers in this facility asking her to autograph God’s Hotel, which was published in 2012 so we know that the horror story she shares is contemporary and too recent for comfort; something like it could happen to any of us. That it happened in a facility where her impeccable credentials as a physician were well-known chillingly sets the frame: the need for Slow Medicine.
Sweet shares the important milestones of her career, explaining the lessons that, over time, brought her to understand a particularly effective approach to diagnosis and medical treatment. In Slow Medicine, “slow” refers more to a frame of mind and an approach rather than to a temporal pace. I once posed a question in Facebook’s Slow Medicine group, asking how members might describe slow medicine in only several short sentences. Of course the discussion veered this way and that; it’s hard to make it an elevator-pitch-length summary. Sweet does not try to condense the definition or the description of her pathway toward slow medicine mastery. Quantifying slow medicine is not the point of this book, understanding the genesis of this re-newed approach, the only approach possible centuries ago, is. Sweet carefully conveys the compatibility between slow and fast medicines and how, paired together, they benefit doctors and patients alike.
Although Sweet closes with a chapter titled “A Slow Medicine Manifesto”, Slow Medicine is a memoir, not a manifesto. I would welcome a future Sweet book that functions entirely as a manifesto. Through it I would hope to receive guidance from a wise doctor for how to find slow medicine medical professionals, and how integrate the slow medicine path as a lay person.
My one complaint is that Victoria’s description of her dad’s almost fatal late life hospitalization refers to but does not describe her own interactions with those treating him. I am left with a host of questions and astonishment that a doctor of her caliber could only get her dad out of that hospital after many weeks, and save his life, [SPOILER ALERT] by pretending that the family was enrolling him in hospice (they did, and hospice promptly kicked him out as they knew it would; he recovered over two months back at home). As one who has written about how to advocate when hospitalized, I really want to know in great detail what she said, tried, thought, and more beyond the snippets she included in the introductory story; to map her efforts to my experiences, insights, and abilities.
Slow Medicine offers a glimpse into this nascent medical movement. Every bit of input helps, and my hope is that some of Victoria’s essence may rub off on me as I, newly of Medicare age, seek Slow Medicine for my last quarter of life.
Making us wish they were our doctors is the primary skill in medicine. If the doctors who were killing Victoria Sweet’s Dad wrote books, they would make us wish they were our doctors too.
A study was done many years ago that pointed out how common it is to be treated for the wrong thing, and treated to death. According to autopsies fully a third of the patients who died in a specific hospital were such patients. It is not new. It is not uncommon. And it is not changing (as it hasn’t in the decades since that study) as long as the information about it comes through the filters of the self-interested perspective of people in medicine.
I can repeat that as often as I want and none of the people reading it will decrease the extent to which they believe what they are told by people in medicine. They still will read books like this and wish the authors were their own doctors without keeping in mind that those authors are not aware of how many of their own patients were such victims. Doctors believe in themselves first and get us to believe in them second.
The real lesson of books like this might be that if they make us wish the authors were our doctors, we haven’t learned anything.
Before responding to Joel I’ll mention that his reflections on medical matters, based like too many civilians on ruinous personal experiences, are insightful and available to read at http://www.patient-safety.com .
That said… this time Joel’s attack saddens me, for reasons beyond his implicit accusation of naiveté on my part. I have made it a point not to paint medicine at large with a black brush, although that restraint does get tried with some regularity upon learning of every new medical outrage.
The only basis on which to posit that every doctor all the time mistreats and overtreats is on a complete rejection of modern medicine. The fact is that medicine works well, even miraculously, much of the time. And that it fails, horribly, much of the time. As elder adults we can expect overselling; we’re wise enough to work through it. The alternative is 100% self-doctoring. Good luck with that, too.
My attraction to a few physician authors is mine, not Sweet’s. She doesn’t ask for anything in Slow Medicine beyond a change in medical culture. That is secondary in this memoir and I have privately suggested that she write an actionable how-to for civilians next. One shortcoming in this book is the absence of detail about how she tried to take on the medical “man” who was intent upon ruining her father and almost did. We all need to benefit from insider info about how to advocate for a loved one during medical matters and hospitalizations. That doesn’t change my from-afar attraction to her medical mind.
I know firsthand how frustrating it is to voice truths that go unheeded. It makes us angry. It can become maddening. We may overreact and undercut our own credibility. Inflating one book or another into the medico-industrial edifice claiming omnipotence is in itself a claim of omnipotence. Don’t go there Joel, you’re very much better than that.