Victoria Sweet describes her training in medical school, residency, and work in various clinics and hospitals. From all of these she forms her own sense of what medical care should include: “Slow Medicine” that uses, ironically, the best aspects of today’s “Fast” medicine.   

Her dramatic “Introduction: Medicine Without a Soul” describes poor—even dangerous—care given to her elderly father at a hospital. An experienced physician, she calls Hospice and saves him from a “Death Express” the hospital has “quality-assured” (pp. 6, 8). 
The book continues with 16 chapters in chronological order. The first ten describe Sweet from a late ‘60s Stanford undergrad and “a sort of hippie” (p.14), next a learner of “facts” in preclinical studies at Harvard, plus the clinical rotations (including Psychiatry, Internal Medicine, Pediatrics, and electives), then an internship as a doctor and her work in various clinics and hospitals. Throughout she’s collecting skills, concepts, even philosophies (Jung, feminism, Chinese chi, value of stories). She also describes particular patients important to her learning. She dislikes “just good enough” medicine at the VA (p. 95), “unapologetic budgetarianism” (p 141), medicine that is reductive and uncaring, and futile care for dying patients.  

Halfway through, we find an “Intermission: In which Fast Medicine and Slow Medicine Come Together.” With a year off, Sweet signs on as physician for a trekking group headed for Nepal. Unexpectedly, she treats an Englishman in the Himalayas. Returning home, she treats a man whose pulse is declining and rides a helicopter with him to a hospital. She realizes that she can take on the full responsibility of being a doctor, including when to use Fast medicine and when to use Slow.  

The following chapters deal with the 1980s emergence of AIDS, a hand injury to Sweet (she sees herself as “a wounded healer,” p. 182), her new understanding of medicine as “A Craft, A Science, and an Art” (Chapter 12) and conflicts between medical care and economics-driven medicine (“checked boxes,” administrators, quality assurance, even outright corruption).  She scorns use of the labels “health-care providers” and “health-care consumers” (p. 211) and discovers Hildegard of Bingen’s medieval vision of medicine. She works for 20 years at Laguna Honda, the topic of her earlier book God’s Hotel (2012). Chapter 16 closes the book with “A Slow Medicine Manifesto.”  

Sweet pays tribute to her teachers, both in a dedication to the book, and throughout the pages: professors, preceptors, nurses—especially a series of Irish Kathleens—and patients. There are some 20 case studies of patients throughout the book, their medical dilemmas, their personalities, and Sweet’s Slow Medicine that involves creating a healing relationship with them, finding the right path for treatment, even watching and waiting.


As in God’s Hotel, Sweet criticizes medicine that is a commodity, that is “evidence-based,” and that is so-called “objective,” therefore treating all patients the same way for a given diagnosis. By contrast, she sees larger and interacting contexts that influence any given patient. She emphasizes the importance of careful physical examinations, patient variations, family and environmental influences, Chinese and Ayurvedic concepts, off-label uses of drugs, prayer, even natural farming and the parallel Slow Food movement from Europe (pp. 237-38, 267-268).  

Sweet is an internist caring for patients with serious, complex illness. She reads clinical papers and—apparently throughout her career—the monumental Harrison’s Principles of Internal Medicine. Yet she firmly believes that doctors need intuition as well as reason. She acknowledges the healing power of “Nature” in human bodies, not just external medical technique that is practiced upon patients. For Sweet, Slow Medicine is an important part of the “Way of Medicine,” the book’s subtitle. Medical care should be multidimensional, not linear, reductive, protocol-driven, or profit-driven.

To be sure, Internal Medicine and medical science have their place but so do wellness, health promotion, patient resources, preventive medicine, family and community support, and the like. 

The book is pleasurable for a wide range of styles. Sweet explains technical material clearly, shares her personal emotions and thoughts, and creates suspense about the paths of individual patients. There are 14 pages of single-spaced notes, and many of these are so interesting we may wonder why they aren’t part of the main text. One note discusses Osler’s witticism that there are three sexes: men, women, and women doctors. Sweet observes, “Perhaps the real ‘third sex’ that women doctors have to learn to be—tough and tender, cool and warm, intimate and objective, doctor and nurse—is, when you come down to it, what all doctors need to learn to be” (p. 278).                                                                                          
An index would be helpful to this book. For example, the interesting Hebrew concept of “Teshuvah” ("repentance," even “turning back”) occurs on pages 103, 180, and 285.    

I recommend this book for many readers, both general and medical, and especially for Health Humanities programs emerging in the U.S., Canada, the U.K., and beyond.


Riverhead Books

Place Published

New York



Page Count