Slow Medicine: The Way to Healing

Image of Slow Medicine: The Way to Healing
Release Date: 
October 16, 2017
Riverhead Books
Reviewed by: 

As much memoir as about clinical medicine, Slow Medicine offers readers the sequel to her nonfiction masterpiece, God's Hotel (2012). Perhaps it is more accurate to say that Slow Medicine is a prequel, taking us on a personal and professional developmental journey from her years in college, medical, and graduate school, learning Latin and medieval history, and her residency and early medical career. These were her path, her “Way” (alluding to an ancient European pilgrimage trail) to the 20 years she spent doctoring at Laguna Honda, the last alms house in this country, which when she began there was a chronic care facility with 1178 patients in San Francisco (which she called God's Hotel).

To discover Slow Medicine, Dr. Sweet needed to master conventional western medicine, "Fast Medicine." As she did. Fast Medicine is what we want for an acute infection, broken bone, or heart failure. Yet for all its wonders, she, like so many medical (and lay) people, came to understand the limitations of our “mechanical model” of modern medicine, with "the brain as a computer, the heart as a pump, the lungs as bellows {and} the kidney as a filtering device" in which the doctor was the "mechanic," there to fix or replace what is broken.

Fast Medicine, as Dr. Sweet so fluently depicts, lacks soul, an appreciation of our body's native capacities for healing and regeneration; we are more like a plant than a machine, she asserts. Instead, what can—and needs to—complement the Fast is what she terms Slow Medicine. This is no Aquarian age hocus pocus. Slow Medicine requires a deep understanding of the body, diet, balance, and professional skill; the removing of obstacles to recovery; and the "tincture of time," to name a few of its ingredients. It also takes courage to practice Slow Medicine, because of how few comprehend (or may denigrate) its value.

Dr. Sweet writes as if she was sitting at our kitchen table, quietly and compassionately teaching about our bodies and our lives. About how to have a better life and what can be done when Fast Medicine fails. And about when the protocols, algorithms, computers and business of medicine blind us to the person with the illness. She offers lessons that go back to the 12th century, to Jung more than Freud, and to the nature of plants with which we humans share more than we have realized.

Whether you are new to or already familiar with Dr. Sweet, you will appreciate how she illustrates her views with stories. Stories about the patients, nurses, doctors, and other fellow travelers in the tangled world we call healthcare. Each story shows, not just tells, how to more likely get it right, or not, and what it means to be a patient or carry the privilege of being a doctor or clinician (not a “health care provider,” that business term that has invaded our lexicon).

As a psychiatrist, I regret that her experience when an intern on psychiatry was so troubling and disappointing to her. Our bad. My profession could surely benefit from her clarity, brilliance, and vision. But just because she became a primary care physician need not keep me and my colleagues from using her ideas!

Dr. Sweet also notes her discomfort with having to (transiently) take the liberty and decision-making away from some acutely psychotic patients, whose reason and self-care have been undermined by psychiatric illness, when involuntary hospitalization or treatment is needed.

I have faced this dilemma countless times, still do; it is not pleasant, usually resented, should be the course of last resort but can be life-saving for the person, their family, and community. The conditions my profession encounters are often chronic, and at times to not bend to reason. They sometimes need doctors to step in and always need her prescription for Fast and Slow Medicine, each augmenting the other.

Opposites are more interactive than contradictory. Instead, their dynamic tension adds rather than reduces their respective powers. Fast Medicine not only can co-exist with Slow Medicine (and vice versa), together they make for better medical care and the healing of our amazing bodies.

Dr. Sweet's narrative in Slow Medicine ends with her starting to write about Laguna Honda, "God's Hotel," having left after it was bled of its humanity. Slow Medicine also beckons the movement in medicine she is championing. She calls for more than the mechanical and the corporate, for health care that is rooted in the person, nature, and the doctor-patient relationship. For Fast and Slow Medicine. Here's to her further and necessary success.