God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine is a fascinating book about physician Victoria Sweet's 20-year experience working at Laguna Honda Hospital in San Francisco -- a ramshackle but charming former almshouse where Sweet was able to practice what she calls "slow medicine."
In an era when doctors spend an average of 10 minutes with patients, slow medicine takes into account, among other things, what Sweet describes as "the fundamental healing process -- or what happens naturally when the body is given enough time."
A captivating counterpoint to the efficiency-obsessed and compromised model of medicine that dominates America's healthcare system today, God's Hotel offers an alluring glimmer of hope. "There are many places where the personal and the inefficient are, in fact, efficient," said Sweet. "Way more efficient." Written in deliciously literary prose, the book has garnered generous praise out of the starting gate, best exemplified by Dr. Oliver Sacks, who enthused: "God's Hotel is a most important book, which raises fundamental questions about the nature of medicine in our time. It should be required reading."
I recently spoke with Sweet about God's Hotel and her vision for the future of healthcare.
What exactly is slow medicine?
In the last 20 years, in the interest of efficiency, the time doctors spend with patients has been cut down to the bone. On average they have 10 minutes to spend with a patient, of which three minutes go to the electronic health records. So we basically have seven minutes to spend with a patient. We doctors really want to connect, but by the time the patient gets him or herself on the examining table, we're down to four minutes. So if I had to summarize in one sentence, I'd say that slow medicine is about having a personal relationship between doctor and patient. I get as much out of it as the patient does. It's a healing relationship that goes both ways.
At Laguna Honda, because it was like a poor house, people simply didn't pay attention to us for the first 10 years that I was there. I had all the time I needed to spend with a patient. It was such a luxury. We had an x-ray department upstairs and could get labs, but everything else was difficult to get. That said, we had the time to use the skills we'd acquired in medical school and during our residencies to talk to patients, to thoroughly examine them, to talk to their families, to look at all their records, call up other docs and try things. And we did it all slowly. It was such a powerful approach. That whole process really takes a lot of thinking, experience and time, but as a physician when I'm finished with that process, I really feel like I know what's going on with the patient.
One can only hope that the pendulum will swing the other way; that in this digital age with things traveling at warp speed, people will start to recognize the virtues of slowing down.
What you just said is the last sentence I just finished writing for my book talk. Literally. I think that indeed we've finally reached an apogee and things are starting to swing back. I'm hoping that God's Hotel will give things a push and help people realize that there are hidden costs associated with efficiency.
You researched and were inspired by the medical work of Hildegard of Bingen. What fascinated you about her?
Hildegard of Bingen was a 12th century German nun and she was a trip. She was a mystic, a visionary, a theologian and a composer who was very famous in her day, then completely forgotten until the third wave of feminism in the '80's. When I discovered her, I decided to go back and get a PhD because I was completely fascinated. She was practicing medieval medicine, but it wasn't about eye of newt and tongue of frog or holy water. It was real medicine for real patients with real diseases that I could recognize.
But Hildegard had a completely different idea than our mechanical model of the body. The idea was that the body is like a plant and that the doctor is a gardener of the plant -- this, as opposed to the idea of the body as a machine and the doctor as a mechanic. The fundamental difference is that someone has to fix the broken machine, but a plant can heal itself. And that healing power of the plant is what Hildegard called it its 'greening power.' She thought that human beings had the same kind of innate healing power and that, therefore, the doctor was more of a gardener whose purpose is to cultivate that healing power -- to nurture it, remove obstructions to it and fortify it.
How can doctors incorporate these ideas and practice slow medicine in a health care system that itself is sick on so many levels?
We doctors are really upset because we actually like doing a good job. Really we do. And we have not been able to practice medicine. Our hands are tied. But I do think there's a lot of good news out there. One of the things that's going on, completely separate from me, is this emerging trend called retainer medicine, also called boutique medicine or concierge medicine. Doctors are really responding to this.
How does the boutique or concierge model of medicine work?
You retain a physician almost like you retain a lawyer, but for way less. You pay a fixed fee every month. A physician I know named Tom charged patients $150 a month -- that was a year and a half ago, so I'm not sure what he charges now -- but in return for that fee, you get a 24/7 real live physician. Tom's practice is a little like community-sponsored agriculture, where the farmers get the money up front and they know how many people they're planting for, and what the people are like. They don't have all these unknowns and have to borrow from the bank. Tom has 200 to 300 people in his practice, which is about the limit of what you can have. But if you do the math, that's as much money as a doctor gets working for Kaiser.
There is a huge movement of doctors recognizing that this could actually be a very cool answer to at least 90 percent of the problems out there. Tom, by the way, told me last year that he is so happy doing this. At the time he saw patients four days a week. He felt so guilty that the fifth day he went to an inner-city clinic and worked for free.
Sounds like a completely parallel medical universe.
That's right. Except what's cool is that you could use your network. You use your insurance to do your labs, do the x-rays, if you have to be hospitalized, whatever, but in terms of the doctor -- that doctor is your doctor and takes care of things for you and then uses your insurance. If you think of it globally, it would probably end up saving money because doctors wouldn't order MRIs just off the top of their heads, for example; they're going to have to do more, but in the end they'll save money. That's the direction I imagine we're going.
Do you really think this model could work? It sounds too good to be true.
No, no, I think it could definitely happen. Here's the advantage of capitalism: If patients do better, doctors do better, staff does better and it's cheaper all around. One of my dreams would be to franchise the whole thing out and become a consultant who helps people set these up all over the country.
So you believe that boomers will make a difference in healthcare and become the change-makers they were in their youths?
Let me tell you, the baby boomers are resurgent. We are different. We always have been. And the same way we took control of our youth, and of child bearing and menopause, we are going to take control of these last years. We are idealistic and energetic. We became householders, had kids and responsibilities. Now the kids are growing up or grown, we're coming out of a certain cycle and into a new one. This is happening all over. There's going to be a wave and it's going to be way cool. I think it's going to be a very interesting revolution.