A Primer on the Slow Medicine Movement
Slow medicine is when a doctor has enough time, and the right kind of attentive, uninterrupted time, to sit with a patient, listen, examine, and get to the right diagnosis and treatment.
Photo by Dennis Callahan
Victoria Sweet, M.D., wants doctors to slow down. She wants them look up from their computers and listen to their patients. She wants them to touch their patients and examine them, hands-on. This is what she calls slow medicine — when a doctor has enough time, and the right kind of attentive, uninterrupted time, to sit with a patient, listen, examine, and get to the right diagnosis and treatment. In Sweet’s opinion, it is more effective and even costs less to spend more time face-to-face with patients and less time documenting electronic medical records, which she finds clumsy and a huge drain on doctor’s time.
“I’ve got time,” said Sweet as she flashed a broad smile during a recent interview. Her speech is warm and enthusiastic, but you can hear the rebel in her voice, too. “Medical care, taking care of the sick, that’s what I was trained to do,” said Sweet. But health care — she struggles with the term; she says it’s a loaded word. “Health care is an economic term derived to look at how much we spend on medicine.” And with that distinction, she noted that the verbs change. “You practice medicine. You deliver and consume health care. It’s the commodification of what I do as a doctor.” She bristled. Illness yields vulnerability and confusion, according to Sweet. She doesn’t believe that sick patients, as “health care consumers,” are able to find the best medicine for themselves. She believes patients need doctors to do it for them, and for that, doctors need time.
Sweet is an associate professor of clinical medicine at UC San Francisco, where she also teaches in the department of anthropology, history, and social medicine. She trained throughout Southern California and the Bay Area in the ’70s and was often attracted to the less-traveled road, doctoring at an inner-city clinic, caring for farmworkers in the Central Valley, working with general practitioners in the wine country. Sweet also treated patients at a VA hospital and served a 20-year stint at San Francisco’s Laguna Honda Hospital, which she chronicled in her first book God’s Hotel. Her second book, Slow Medicine, published in 2017, covers her diverse medical career and provides her recipe for slow medicine. “The book is a slow medicine manifesto disguised as a memoir,” said Sweet laughing. She is not against what she terms fast medicine, the use of today’s many diagnostic tools, life-saving technologies, and telemedicine — in the proper place. But she firmly believes that medical care is individual. Slow Medicine outlines her approach to healing through the art and science of slow and fast medicine, combining touch with technology, without being a slave to algorithms or burdened by forms.
Sweet recalled her days at San Francisco’s old Laguna Honda Hospital, which cared for the underserved and chronically ill. “Patients bounced around and were admitted on 15, 20, or more different medications and often needed only five. It took time to wean them off and find the right combination of medications, but that alone was a huge cost savings,” she said. The ample time Sweet had to work with patients at Laguna Honda, to sit with them at the bedside, served as an inspiration and foundation for her advocacy of slow medicine.
“Slow medicine is slow in the same way that slow food is slow,” said Sweet. In fact, the slow medicine movement originated in Italy as a follow on the slow food concept, she added. “Like starting with good ingredients and caring about how things are prepared to make good food, it’s a way of practicing good medicine, knowing your patient and how to do a thorough examination to get the right information.”
And yes, slow medicine is a movement, affirmed Sweet. Although published data are limited so far, medical researchers at Harvard and the University of Chicago are studying the efficacy and cost-effectiveness of the slow medicine approach. So where does the slow medicine movement go from here? Sweet believes patients will see slow medicine specialists in the future. She would like to see slow medicine beds in the hospital for complicated patients who need more time to heal, and slow medicine clinics for follow-up and where doctors can refer their most complex patients who take more time to treat.
Not everyone needs slow medicine, acknowledged Sweet, it’s probably most necessary for the sickest patients, the top 12.5 percent on the health care cost ladder, she said, but everyone should have access to it.
What role do patients play in slow medicine? Patients are entitled to be looked at, talked to, touched, and examined, said Sweet. “If the doctor is typing away, ask her to look at you.” She said she wrote Slow Medicine to be accessible to both patients and clinicians. “I wanted slow medicine to be the name of the tent that people could get under. And, it is becoming the way people talk about what I’m talking about.” She likes the idea that slow medicine is counterculture, the way it’s working into the parlance of health care today. “Being slow is cool, you know,” said Sweet.