Montage | Open Book
A former physician, now associate clinical professor of medicine at University of California, San Francisco, Victoria Sweet, G ’73, is appalled by the depersonalization of healthcare in its technological, institutional manifestations. In Slow Medicine: The Way to Healing (Riverhead, $27), she recounts what transpired when her father suffered a grand mal seizure and was hospitalized—on the incorrect impression that it was his first such incident and that he might have suffered a stroke. From the introduction:
I’d known that healthcare was getting ever more bureaucratic; that doctors and nurses…were spending more and more of their time in front of a computer screen entering health-care data. I’d experienced it myself. But until that week, I had no idea how bad it had become. If I, as a physician, couldn’t get appropriate care for a family member in a lovely community hospital with well-trained staff—who could?
What had happened to medicine and nursing? I asked myself.
To find out, I ordered up Father’s electronic health records and went over his near-death experience.
The document was 812 pages long and took me four hours to read. It began not with the doctors’ notes but with hundreds of pages of pharmacy orders; then hundreds of pages of nursing notes, which were simply boxes checked. Only the doctors’ notes were narrative, and mostly they were cut-and-paste. No wonder no one could figure out what was really going on. Still, to be fair, although I found mistakes in the records, Father had, after all, gotten discharged….I had to admit, judging by those electronic health records, his stay in the hospital looked 100 percent quality-assured.
There was just something missing. And it was hard to put my finger on it.
Everything looked so good in the computer, and yet what Father had gotten was not Medicine but Healthcare—Medicine without a soul.
What do I mean by “soul”?
I mean what Father did not get.
Presence. Attention. Judgment.
Above all, responsibility. No one took responsibility for the story. The essence of Medicine is story—finding the right story….Healthcare, on the other hand, deconstructs story into thousands of tiny pieces…for which no one is responsible.
A robot doctor could have cared for my father just as well.