Wednesday, September 10, 2014

An Inspiring and Sobering Look at The Intersection of Modern Medicine and Pre-Modern Medicine: Review of "God's Hotel" by Victoria Sweet

Dr. Victoria Sweet, MD, Ph. D., has penned a book about her twenty years as a staff physician at the legendary Laguna Honda Hospital, the last remaining "Alms House" in the U.S.  Her journey through those twenty years of tumultuous change has been framed as a pilgrimage in which she has learned lessons from her patients, her colleagues, and the ancient practices of Sister Hildegard of Bingen, Germany.  And is is fitting that she should choose this format to share her thoughts, lessons and experiences, for she spent several summers making an actual pilgrimage in Europe - the legendary Compestela Pilgrimage.  It is clear that she took those spiritual and practical lessons she learned along those treks and integrated them into the ways in which she interacted with her patients and with her colleagues.

As soon as I was a few pages into this book, I knew that I could not wait to share its many insights with two close friends - one a practicing physician and the other an applicant to medical school.  The three of us had lunch last week, and Dr. Tony began to describe his frustration in trying to treat a young schizophrenic patient who refused medication.  It was an exact parallel to a case that Dr. Sweet had described in a chapter of "God's Hotel."

Dr. Sweet's holistic approach to medicine can best be summoned up in this quotation from an early chapter in the book:

"He [Dr. Curtis] reminded me of an aphorism I loved but had never understood it. 'The secret in the care of the patient is in caring for the patient.'  I'd always assumed that it meant caring about the patient - loving or at least liking the patient - but when I saw Dr. Curtis rushing off to put shoes on a patient he barely knew, I thought there must be more to it than that.  So I tracked down the quote and found it in a talk by Dr. Francis Peabody to the graduating medical class of  Harvard in 1927.  It turned out that Dr. Peabody didn't mean caring about a patient but caring for a patient, which he explained, meant doing the little things, the little personal things that nurses usually do - adjusting a patient's bedclothes or giving him sips of water.  That took time, Dr. Peabody admitted, and wasn't, perhaps, the most efficient way for doctors to spend their time.  But it was worth it, he told his students, because that kind of time-costly caring was what created the personal relationship between patient and doctor.  And that relationship was the secret of healing." (pp. 91-92)

Malcolm Gladwell makes a similar point in his book "Blink" in discussing why some physicians are never sued for malpractice.

I found this book both thrilling and sobering.  Thrilling to think that there was a team of physicians earnestly trying to hold back the tide of impersonal Managed Care.  Sobering to learn that they were losing that fight to a tsunami of consultants, government inspectors, efficiency experts, bean counters and marketing gurus who were pushing for more efficiency and quicker healing and discharge of patients.

This book is a must read for anyone practicing health care, and for anyone concerned about the future of medical practice.



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