WASHINGTON — Dr. Victoria Sweet had been practicing medicine for about 10 years before she even heard the phrase “health care.”
At the time, she recalled, it was just an economic concept describing how much is spent on treatment. “But it pretty soon got turned into a thing that was provided and consumed,” she said.
This semantic drift reflects a system that she believes treats the patient more as a consumer. The idea of “health care,” she contends, turns a doctor into a middleman. An intimate bond with the patient is lost.
“It is a completely wrong-headed model of what happens when you get sick and what a doctor does,” Sweet said.
The Guggenheim Fellow‘s latest book, “Slow Medicine,” illustrates how the system can be improved with a more thoughtful approach to treatment — one of attention, kindness and “above all, responsibility.”
The pros and cons of ‘fast’
While modern medicine does a great job in acute situations (e.g., infections, traumas), she said, it could be more thoughtful in its approach to chronic conditions (e.g. diabetes, autoimmune diseases). Sweet cites an example of how her father nearly died in a hospital just because he had forgotten to take his seizure medication. He needed a pill and some rest, she writes. Instead, he was put on a “stroke protocol” and placed in restraints.
“What we’re not good with is the actual diagnostic part, the part where the patient first comes in and knows something is wrong,” said Sweet, currently an associate clinical professor of medicine at the University of California, San Francisco Medical Center.
Her “slow” approach doesn’t necessarily mean one that consumes more time. It means an approach that increases face-to-face time, as well as a “methodical kind of thinking about how everything fits together for this particular patient,” she said.
“Do they need all the medications they’re taking?” she asked. “And what can [doctors] do to remove what’s in the way of this patient feeling well? And what can they do to nourish what’s strong about them?”
Effecting a widespread shift toward this “slower” approach, she said, in part means scaling back the emphasis on electronic records, which are taking up an ever-growing share of doctor-patient time.
If a doctor “spends all of her time in front of the computer filling out little boxes and providing data for billing and pharmacy and all that, then there’s no time with the patient,” Sweet said.
“So until the doctor has that time back, there’s no way what I’m talking about can be in that interaction.”
Finding it in DC
Wider availability of a “slower” approach helps with a systemic shift as well, she said. Around D.C., patients can find it at various concierge medical practices, which charge a monthly fee in return for a doctor whose patient number is limited.
“Many doctors have figured out a way they can practice this kind of medicine,” said Sweet, who sees potential in “slow medicine” becoming its own specialty, with practitioners who can spend extra time on their more complicated patients.
And of course, Sweet would like to see that mainstream vocabulary shifted back. Instead of “health care providers” and “health care consumers,” she’d like to hear “doctors,” “nurses” and “patients” more frequently.
“Medicine, as I know it, happens between a ‘doctor’ and a ‘patient,’” she said. “The patient usually comes to me because they’re sick. They’re freaked out. There’s a new lump. They’re vomiting. They’re freaked out. They’re sick.
“And this has nothing to do with being a ‘health care consumer.’”
