...I learned a Slow Medicine lesson: how individual medicine was. It wasn't true that one size fits all, that everyone or no one should have that treatment or this pill. Rather, the right answer had to do with style, with who you were, who the patient was.

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Everything looked so good in the computer, and yet what Father had gotten was not Medicine but Health Care-- Medicine without a soul. What do I mean by "soul"? I mean what Father did not get. Presence. Attention. Judgment. Kindness. Above all, responsibility.

I had the time to try things, to stop others [referring to medications]. And what impressed me was how efficient it was and how much money I saved by having that extra time. And I will give an example. Most of the patients I met for the first time were very sick for a long time, and most of them, on average were on between 15 and 26 medications. Most of them only needed three or four of these medicines but no other doctor had the time to go through and find out, try this or take them off.

[In likening Slow Medicine to Slow Food:] Slow Food was not really about fast or slow in time. Rather it was about privileging the basics-- the ingredients, which do take time: farmers' time and gardeners' time, and also their skill, experience, and knowledge. It was about accepting what is-- the seasons, weather, climate-- and flowing with it, not against it. It was about removing what is in the way of a plant being the healthiest, the most fertile, the happiest it could be, and doing so by little actions, by fussing and fiddling. That was how it was "slow."

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[Regarding the saying "the secret of caring for the patient is caring for the patient"] The way we talk about patient care in our society is almost the opposite of what's actually happening. It's almost like the less we care in any way for the patient the more people talk about the patient, the "consumer" of health care. What was actually meant by that saying was that caring meant doing little things for them; it's the little things that establish the relationship between you and the patient, not some abstract "love for your neighbor." It's doing something actual and physical for this neighbor.

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The essence of Medicine is story-- finding the right story, understanding the true story, being unsatisfied with a story that does not make sense. Healthcare, on the other hand, deconstructs story into thousands of tiny pieces-- pages of boxes and check marks for which no one is responsible.

What I discovered was that the two ways of looking at the body—the modern and the premodern, the Fast and the Slow, as a machine to be repaired and as a plant to be tended—are both effective when they are applied to the right patient at the right time. For illnesses that come on suddenly—an inflamed appendix, a rip-roaring infection, a car accident, a heart attack—it is best to think like a mechanic—boldly, reductively. What is broken? What should I do to fix it? Desperate illnesses require desperate remedies. But not-desperate illnesses do better with not-desperate remedies. Diseases that come on slowly—chronic infections, complex medical conditions, the aftermath of the appendectomy, the heart attack, the chemotherapy—are best approached like a gardener, asking myself as Hildegard would have done, not what is broken but what is working? What are my patient's strengths and how can I support them? What can I do to nurture viriditas, the natural power of healing?

Every time a new drug comes out, I read what the side effects are and how many people really get better, and I add in the side effects and the adverse reactions. When you do that, and subtract out the placebo effect, not many new medications make a difference.

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