Author: Victoria Sweet
What invaluable lessons could modern medicine possibly learn from the healthcare of the middle ages? This is the question at the heart of this book which examined the medieval medical tradition of Hildegard of Bingen, the acclaimed multi-talented German nun and healer. The book specifically explored how Hildegarde’s healing methods transformed the author’s clinical practice at the appropriately named God’s Hotel-the nickname of Laguna Honda, a hospital established to take care ‘of those who couldn’t take care of themselves’ (page 8). Blending modern medical treatments with Hildegarde’s age-old healing traditions, the author developed her own surprisingly effective concept of ideal medical practice. Whilst the book’s main focus is clinical, espousing the highest standards of compassionate patient care, it also chronicled the progressive erosion of health care by disruptive ‘efficiency’ policies, and offered a revitalising view of the spiritual dimension of medicine.
The author dedicated a major part of her book to exploring the foundations of the pre-modern medicine of Hildegard of Bingen, comparing it most favourably with the principles of modern medicine. She detailed the horticultural mindset of Hildegardian medicine which conceives of the human body as a garden, and which views treatment as the nurturing of the body back to greenness, or viriditas. This contrasts sharply with the modern medical perception of the body as a machine or a computer, and its perception of treatment as the repair of ‘mechanical breakdown‘ (pages 6, 49 and 200-204). The author described how Hildegardian medicine cured her own severely impaired patients whose ailments had defied modern medical interventions; this revelation radically transformed the author’s practice, and inspired her to develop the novel concept of ‘slow medicine‘, a time-intensive but cost-effective approach to healing (page 110). She strongly advocated this forgotten but valuable concept of curing diseases, arguing that it is ‘active in our thoughts and desires‘ even though ‘scientific modern medicine’ has tried to erase it (page 33).
Almost as compelling as the book’s exploration of medieval medicine is its damning critique of the impact of modernisation and politically-driven policies on health care. Charting her own experience at Laguna Honda, the author demonstrated how the health policy decisions taken in the 1980s and 1990s changed the ethos of health from the honourable ‘practice of medicine‘, to the nebulous ‘delivery of health care‘. With several examples, she described how these efficiency policies, driven by ‘a whole new generation of medical historians‘, politicised health care and eventually destroyed medical professionalism (pages 75 and 282). She highlighted the absurd outcomes of these policies when she pointed out that they required the introduction of ‘new forms, new committees, and new training‘, and this meant that ‘more attention was given to documents, and less time spent with patients‘ (pages 125-126). Reflecting on these unintended consequences, the author remarked rather sarcastically that ‘all the plans, policies, and procedures didn’t clean any gurneys, turn any patients, or pick up any slippers off the floor’ (page 268).
The author’s most scathing criticisms were reserved for the detrimental effects of the policy interventions on the patient-doctor interaction. She symbolised this by how the new policies left her with very little time to ‘see my patients, sit on their beds, and listen to their stories’ because they required her to spend more time behind a computer, ‘providing health-care data so that administration could prove that Laguna Honda provided cost-efficient, culturally competent care’ (page 386). She also described how the ‘misguided’ cost-saving measures, by reducing the number of nurses and other clinical staff, and by increasing the number of middle managers, increased the stress levels of healthcare staff. This, expectedly, resulted in more illnesses, more sick days, more injuries, more disabilities, and earlier retirements, a farcical situation she aptly termed ‘the inefficiency of efficiency‘ (pages 80-84 and 144). She argued that the older paradigm of ‘the efficiency of inefficiency‘ worked much better because it resulted in better healthcare outcomes by creating the time and the ‘mental space‘ to ‘focus and care‘ (page 85).
The author’s exploration of the spiritual dimension of medicine was a major theme of the book in which she probed and negotiated the tricky boundaries of the spirit and the body, or the spiritus and the anima (page 3). She declared that, as a Catholic, she was personally attracted to medicine because of how it engages in what she called ‘the last things‘: death, resurrection, heaven, hell, and purgatory. She also disclosed her fascination for the ‘indefinable‘ facet of medicine which she construed as the ‘subtle but shared world…of invisible connections with visible effects‘ (page 4-5). She discussed how this dualist medical philosophy, scientific and spiritual, has determined her approach to patient care, illustrating this for example when she said, ‘no matter how demented a patient seemed, it just might be that deep within he still had his anima, his soul. If we could just get to it’ (page 194). This rather abstract but conceivable spiritual view pervades her clinical practice, such as when she described the ‘shared, peaceful silence‘, and the ‘healing space‘, which exists between physician and patient. She described the effect of this on her work with several examples, such as how she often resolves difficult diagnostic cases by ‘just sitting‘ with the patient for a short while, a strategy that often reveals the subtle clues to the diagnosis (pages 44 and 326-327).
More than anything else, this book is a study in compassionate patient care, and the author illustrated this with many catchy aphorisms and anecdotes. She said, for example, that ‘even when there is nothing to do for a patient-there is still something to do. It doesn’t have to be lifesaving, grandiose, and heroic. It can be as simple as a pair of glasses or a different diet’ (page 35). Paraphrasing Francis Peabody‘s time-honoured saying, she added that the secret of caring for patients is in doing ‘the little personal things’ which often ‘solved a problem quickly and definitively‘ (pages 91-93). In a similar vein, she criticised the Hippocratic medical principle which ‘requires that the doctor maintain a certain distance‘ from the patient, arguing that this ‘means not quite being yourself’ (page 279). Her empathetic approach to her patients was perhaps best manifested by her interaction with the blind and mentally retarded Mr Gillion who taught her that ‘there was something to be said of pure existence; that none of us knows what is valuable to God’ (page 239).
In this very stimulating expedition into the essence of medicine, the author takes us through her academic and spiritual journey of discovery which culminated in the blending of scientific with intuition-based spiritual care. The book also explores the policy-driven disruptive transformation of patient care that most doctors will recognise, and it demonstrated how flawed modernisation may disorganise the health care service. Her observation of the impact of efficiency changes on the quality of patient care is most perceptive, and her insights covered the whole range of medicine, from ward care to health management. The spiritual aspect of her medical practice is perhaps at odds with the prevailing scientific paradigm, but she portrayed it in such as way that it made intuitive and practical sense. The author’s prose is direct, clear, and dispassionate from the start, and the book is a pleasure to read.
This book is a strong commentary on the state of medicine as a whole, and a loud clarion call to reassess modern medical care. It is also a critique of the drive for efficiency which has taken priority over compassionate patient care. The book urges readers to recognise the need to give patients adequate time to address the little things that matter the most to them. The author’s open acknowledgment of a spiritual context to medicine is quite brave in the modern medical era which is doggedly regimented in its scientific paradigm. This is essential reading for anyone involved in healthcare and I highly recommend it to all doctors.
Publisher, Place, Year: Riverhead Books, New York, 2012
Number of chapters: 12
Number of pages: 416
Star rating: 5