We all know the current US healthcare system is broken. But is it beyond repair? Victoria Sweet, MD, PhD, doesn’t think so. Her disdain for crippling governmental regulations coupled with her integrative approach to healing – combining the best of Old World medicine with the technology and medicines of today – might just be the key to making the solution for effective, efficient healthcare a reality. Her book, God’s Hotel: A Doctor, A Hospital, and a Pilgrimage to the Heart of Medicine, explores the theory that we’ve sacrificed patient care at the altar of efficiency, and she has a prescription to get us back on track.
I first stumbled upon God’s Hotel in 2014 when a friend of mine had insomnia and Instagrammed her late-night snack and current read. The title looked interesting, so I asked her about it. She told me it was fascinating and involved St. Hildegard von Bingen. She had me there – I was just beginning to learn more about St. Hildegard and was intrigued by her approach to medicine as an infirmarian of her Middle Ages monastery. So, I went ahead and requested the book from the library.
God’s Hotel is a summary of Dr. Sweet’s time (1980s-early 2000s) working at Lagunda Honda in San Francisco, one of the last remaining almshouses in the United States. The title of the book references the history behind the origin of almshouses in general – healthcare facilities for the poor that were originally run by religious orders. The oldest surviving almshouse in the world is The Hotel Dieu (literal translation is “God’s Hotel”) located in Paris next to the Cathedral of Notre Dame. At one time, there were taxpayer-funded almshouses in nearly every county in the US, but they began to be shuttered in the 1950s due to pressure over economics from the political right and concerns about social justice from the left. Dr. Sweet discusses the history of their decline, along with giving valuable insights on the concurrent decline of mental healthcare, within the pages of her text.
Laguna Honda, then, stood alone as a monument to our collective past. There were open wards where long-term patients found solace in companionship; unhurried doctors who were able to spend time with each patient and truly care for their bodies and souls; and a noticeable lack of overreaching bureaucracy – all tenets of a bygone era in medicine.
During this time, Dr. Sweet began working on her PhD in medical history, studying in particular the works of St. Hildegard von Bingen. In the course of her research, she discovered that the Medicine of the Middle Ages was less relying on “eye of newt” tinctures, and far moreso a radically different approach to the doctoring the human body. Hildegard believed in enabling the body to heal itself, which is radically different from the modern model of medicine which equates the physician to a mechanic, “fixing” a body like a machine. Because Laguna Honda was, at the time, not under intense scrutiny from governmental regulatory agencies, she was able to employ some of St. Hildegard’s approaches to healing with her patients.
Dozens of such stories are chronicled in the book, and the recoveries of her patients are remarkable. In each instance, Dr. Sweet removed obstacles to the patient’s inborn ability to heal itself – referred to as their veriditas by Hildegard – and in each case, the patients recovered well, if slowly. Namely, she focused on ensuring the patients were as comfortable as possible; experienced deep, restful sleep; had access to plenty of sunshine and fresh air; and consumed real, healthful foods. In the course of her work, Dr. Sweet recognized the effectiveness and necessity of modern medicine in treating emergent and serious conditions, but she also began to embrace the idea that integrating the best of old and new approaches is the most crucial way we can improve patient outcomes.
In addition to overhauling the overall approach to patient care, Dr. Sweet explores the gradual but relentless advent of crippling regulations that have driven up the cost of healthcare and continue to contribute to the lack of time doctors are able to spend with patients. Having worked in various healthcare settings, I can personally attest to the sheer amount of time that clinicians and nursing staff must spend ensuring patient documentation is completed. The introduction of electronic health records (EHR) was supposed to help reduce overall charting time, but in my own experience seems to further reduce the attentiveness of the physician to the patient and results in an overall more complex, burdensome method of record-keeping. Recognizing the potential value of EHRs, Dr. Sweet has suggested streamlining and refining existing software to more closely mimic more traditional charting techniques, while retaining the ability to prevent medical mistakes. Additionally, she calls on government regulators and CMS to invest time and research funding to explore the efficiency possible when doctors are truly allowed to spend time with their patients, unencumbered by daily patient quotas and stifling insurance guidelines.
Of additional interest to a Catholic nerd like myself was that not only did Dr. Sweet immerse herself in the teachings and recipes of St. Hildegard (going so far as to make some of Hildy’s Anti-Depression cookies!), she also completed the Camino de Santiago (The Way of St. James) over the course of several summers. Throughout the book, she gives Catholics major credit for their care of the poor, influence on history, and (especially rare for a modern scientist!) the huge impact the Church has had on the discoveries of medicine.
This week, I took a quick trip to San Antonio to hear Dr. Sweet speak at the University of Texas – San Antonio Center for Medical Humanities & Ethics for their Ewing Halsell Distinguished Lecture series. My almost-paramedic brother came with me, and we took my two eldest kiddos. We were fascinated with the hourlong talk, and were especially fortunate to be able to meet and chat with the good doctor afterwards. In my opinion, she’s doing valuable work to bring the idea of “ineffcient” medicine to the forefront of the ever efficiency-minded healthcare community, and I am particularly encouraged by her ideas for opening slow medicine clinics around the country. If you’re interested in learning more, you can watch the video of her Ted Talk below and visit her website at http://www.victoriasweet.com/.