A recording of this presentation is available HERE.
Many thanks to Dr. Paul Nguyen, who gave a moving and important Grand Rounds this week, which he entitled "Slow Medicine: Reflections from a 3rd year resident". What was so compelling about his presentation was how he brought us back to the basics of why most of us came to family medicine in the first place and wove in his reflections on where the rub occurs, and how we might approach it to make it better for patients and for us.
I particularly appreciated his inclusion of two Vietnamese proverbs, which I will leave here for your consideration:
Translation: You only know you're hungry after eating.
Meaning: You may only understand the importance of something once you have experienced it yourself.
Translation: Keep grinding the metal, one day it will turn into a needle.
Meaning: If you keep putting in the hard work, you may wind up with something beautiful and useful
In between these two beautiful proverbs, Dr. Nguyen introduced us to Victoria Sweet's book, Slow Medicine (if you haven't read it, both he and I highly recommend it!) and highlighted some of the core tenets she promotes in her book:
1) Gevuld (Dutch for "stuffed"), in the contest of medicine the idea that wounds can literally fill themselves in, that the body knows how to repair itself, that illness is not always an enemy to defeat. In this model, physicians are stewards of processes, not commanders of outcomes.
2) Slow ≠ passive: medicine doesn't always require an intervention, time itself may heal. Sometimes the best intervention isn't doing more-- it's doing less. Not ignoring or neglecting but allowing the body's processes to work.
3) Observation: observation is itself an active clinical skill, paying attention matters, and watching the body heal itself may be our only duty. Tolerating uncertainty is another part of our job.
I particularly appreciated this slide from Dr. Nguyen, summarizing Sweet's argument and contrasting "fast medicine" (how we do things) to slow medicine (how he wants us to consider doing them):
In this section, he talked about the contrast of metrics vs. meaning, of productivity vs. presence and shared some of the data regarding burnout in the primary care workforce as well as patient perceptions of being held/cared for based on time spent with them.
And for those of us who have been through residency and/or are witness to our residents going through residents in this era, we can related to these tensions, the feeling of not having enough time to sit with patients BUT wanting nothing more than to have the time to do so. The feeling of data overwhelm without a true understanding of the patient's lived experience.
Dr. Nguyen shared with us two meaningful patient experiences he has had during his residency training-- one that ended with a peaceful death, the other that left a patient without a diagnosis but getting better (who knows why? perhaps it was the time he spent with her?).
And, finally, some wisdom for his juniors and colleagues:
