With butterflies in my stomach, I nervously entered Chehalis Family Medicine to complete my medical assisting (MA) internship. Stacey, an attractive woman with straight medium length hair and chestnut colored eyes, introduced herself as my preceptor. She quickly showed me around the clinic and pulled up the patient schedule. “Our first patient is in room 9. The most important thing to keep in mind is to not keep the doctor waiting. In and out.” I shadowed her as she moved quickly from room to room as if on roller skates. Chief complaint, allergies, medication list, medical/surgical history review, preventative health maintenance- immunizations, blood work, cancer screening, and vital signs were all addressed in under 5 minutes. She then popped out to give the doctor an overview of the patient visit. I watched as she threw a stack of consults on the desk and began updating patients’ electronic medical records. She called patients to relay imaging and blood work results at the same time. ‘’Stacey I’m going to biopsy the lesion. Please set up the tray,’’ Dr. Lee called out. I on the other hand, fumbled when placing the blood pressure cuff on patients’ arms, sweat dripped down my back as I prepared to give injections or venipuncture, and I slurred my words on the telephone. Everything was done slowly and consciously. It wasn’t too long though before I learned to pick up the pace. Stacey taught me how to be fast; after years I became what my instructor calls “seasoned.” This was my first glimpse of healthcare as I know it.
Slow Medicine The Way To Healing by Victoria Sweet has given me a new perspective on how medicine should be practiced. She begins by sharing about a time when her father received the incorrect diagnosis upon being admitted to the hospital. This clear error changed the whole course of her father’s treatment and almost caused his death. She goes on to distinguish between medicine and healthcare. Victoria states “What father had gotten was not Medicine but Healthcare-Medicine without a soul.” She defines soul as presence, attention, judgement, kindness, and responsibility. She explains that medicine deals with finding the true and right story. Victoria then brings attention to the different versions of medicine. She describes modern medicine’s view of the body as a machine. When I took courses for my MA program, the instructor also referred to the human body in this way. The doctor is the equivalent of a mechanic who must fix the broken part(s). She sheds light on an alternative model of understanding a patient, through the lens of pre-modern medicine. The body is like a plant and the doctor therefore acts like a gardener.
One of the major faults she identifies within the healthcare system is its fast pace. The medicine we should strive for is slow. This simple change allows the doctor to see the patient in a whole different light. She warns: “Don’t miss the obvious.” By this Victoria means that the diagnosis is written on the body. She proves this time and again. One captivating story she shares deals with a pediatric patient named Marcela Hernandez who was admitted for renal failure. With the help of fast medicine’s technological advances, multiple tests and work ups finally led to the correct diagnosis (neurofibroma). Victoria awaited for Marcela’s mother so she could share her finding. She is left stunned when she meets with the mother because she is covered in neurofibromas! Victoria recollects “All that effort, intelligence, and expense to get that brilliant rare diagnosis and all it had needed was one look at Mrs. Hernandez.” The diagnosis had been visible the entire time. Another clear is example is that of Joey Canaan, a pediatric patient who had drowned in a pool. He had survived but was admitted to the ICU and relied on a ventilator to help him breathe. Despite numerous tries, Joey’s body did not have the capacity supply oxygen on its own. The doctors thought he was a lost cause due to excessive scar tissue from the water and pressure of the vent. Before pulling the plug ,the pulmonologist instructed the attending physician to try decreasing the pressure and volume of the vent slowly. Joey began to respond and within three weeks was breathing entirely on his own. By week 6, he was discharged and went home to resume a normal healthy life. This goes to show that sometimes fast medicine isn’t enough-it’s the steady, consistent, and slowness of time that will allow one to heal.
Having already had a little bit of experience in healthcare, I can relate to many points Victoria brought up. I recall filling in for a medical assistant in internal medicine and pulling up the schedule to see patient appointments every 20 minutes from 8 am to 5 pm. All day long I weaved in and out of rooms doing my best to make sure we didn’t fall behind schedule. These were elderly patients most with complex medical issues. How did the doctor have time to fully address their needs? I questioned his model of patient care because being in a rural underserved medical area, my doctor and I struggled with even 40 minute appointments. Patients were asked to keep their chief complaint to a minimum of 1 but the doctor always ended up discussing 4-6 additional issues. As I resigned from my position, management was pressuring doctors to increase their patient panel, which would increase revenue. The turnover of doctors and nursing personnel has dramatically increased at my clinic as a result. I agree that not much is needed to make medicine better than it is. Everybody needs to just slow down.
The dynamic of gardener and plant approach to healing was very fascinating to me. Victoria describes the process as taking a step back and observing the patient in his own environment. The doctor asks himself “ What’s in the way of the patient’s own healing power of Nature?” It is then up to the doctor to remove whatever obstacle is impeding the patient from thriving. There are many who don’t realize or have forgotten how amazing the human body truly is. Oftentimes, people go into the doctor’s office with the expectation of being “fixed” right away. Many times that’s not the case, which leads to frustration and anger. Today I was reminded of the self healing capabilities we possess. All we need is a little patience and time.
With a higher education, I hope to help patients on a more personal level. Being placed in the patient’s shoes what type of care do I hope for? One of empathy, compassion, and support, which is what I have aimed to abide by from the start.The provider should be the patient’s greatest advocate. As I gain a deeper understanding of medicine,I hope to always keep in mind the integration of fast and slow medicine to help people heal. It starts with simply the slowing of footsteps and a listening ear.