WASHINGTON 鈥� 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 鈥渉ealth care,鈥� 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 ‘s latest , “Slow Medicine,” illustrates how the system can be improved with a more thoughtful approach to treatment 鈥� 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.
鈥淲hat we鈥檙e 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 鈥渟low鈥� approach doesn鈥檛 necessarily mean one that consumes more time. It means an approach that increases face-to-face time, as well as a 鈥渕ethodical kind of thinking about聽how everything fits together for this particular patient,鈥� she said.
鈥淒o they need all the medications they鈥檙e taking?鈥� she asked. 鈥淎nd what can [doctors] do to remove what鈥檚 in the way of this patient feeling well? And what can they do to nourish what鈥檚 strong about them?鈥�
Effecting a widespread shift toward this 鈥渟lower鈥� 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 鈥渟pends 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鈥檚 no time with the patient,鈥� Sweet said.
“So until the doctor has that time back, there鈥檚 no way what I鈥檓 talking about can be in that interaction.鈥�
Finding it in DC
Wider availability of a 鈥渟lower鈥� 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.
鈥淢any doctors have figured out a way they can practice this kind of medicine,鈥� said Sweet, who sees potential in 鈥渟low medicine鈥� 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 鈥渉ealth care providers鈥� and 鈥渉ealth care consumers,鈥� she鈥檇 like to hear 鈥渄octors,鈥� 鈥渘urses鈥� and 鈥減atients鈥� more frequently.
鈥淢edicine, as I know it, happens between a 鈥榙octor鈥� and a 鈥榩atient,鈥欌�� she said. 鈥淭he patient usually comes to me because they鈥檙e sick. They鈥檙e freaked out. There鈥檚 a new lump. They鈥檙e vomiting. They鈥檙e freaked out. They鈥檙e sick.
鈥淎nd this has nothing to do with being a 鈥榟ealth care consumer.鈥欌��
