‘Doctors Tell All—and It’s Bad’

Meghan O’Rourke, writing for the Atlantic:

What I was looking for, it turns out, was a doctor like Victoria Sweet, and the kind of care offered in, of all places, a charity hospital in San Francisco. A doctor who is able to slow down, aware of the dividends not just for patients but for herself and for the system: this is the sort of doctor Sweet discovered she could be in “the last almshouse in America,” as she calls Laguna Honda Hospital, a funky old facility for the destitute and chronically ill, where swallows flew through open turrets and 1,200 patients lay mostly in old-fashioned “open wards,” and where she worked for 20-some years. In her remarkable memoir, God’s Hotel, Sweet—who is also a historian of medicine versed in the medical work of the 12th-century nun Hildegard of Bingen—calls her radical solution for our sped-up health care “slow medicine.” Here is a doctor saying what patients intuitively know: being sick is draining, healing takes time, and strong medicine often has strong side effects.

Granted a capacious amount of time and freedom with her severely ill patients (many of them drug addicts, schizophrenics, or elderly and with few resources), Sweet is able to make diagnoses that her patients’ previous doctors missed. Relying on close observation to help her understand what’s really going on, she weans them from an average of 20 medications to six or seven. She finds that discarded medical practices—for example, manipulating the lymphatic system with an old-fashioned medical girdle—may have more to offer than contemporary interventions do. In one heartbreaking case, she realizes that an elderly patient is not suffering from Alzheimer’s following a hip surgery, as doctors at the woman’s former hospital concluded—a diagnosis that led to antipsychotic medicines, her removal from her own home, and her separation from her mentally disabled daughter. Rather, she is in pain: the hip had slid out of place, and no one responsible for her follow-up care had noticed.

A long time ago, in a galaxy far, far away…

This doesn’t just sound like another era, it sounds like another universe!

O’Rourke’s real point is that medical care today is dehumanizing for both patient and doctor, and that yields worse outcomes for everyone. She attributes this dehumanization to the practice of cramming patients in to busy schedules, and claims that costs might actually drop if doctors saw fewer patients and thus made fewer bad calls.

Not sure I buy it, but I’d be willing to try it!

‘Where Young College Graduates Are Choosing to Live’

Claire Cain Miller, writing for the New York Times:

Denver has become one of the most powerful magnets. Its population of the young and educated is up 47 percent since 2000, nearly double the percentage increase in the New York metro area. And 7.5 percent of Denver’s population is in this group, more than the national average of 5.2 percent and more than anywhere but Washington, the Bay Area and Boston.

I visited Denver a few years ago — it was far more young and hip than I expected, and I had a good time.

Speaking more generally, this is a highly unsurprising finding. The old suburban ideal does not really seem to appeal very much to today’s young and educated. And when it does, it’s likely to be inner suburbs — cities like Oakland — than far-flung suburbs with tons of space and restrictions on housing development.

But I would be very curious to understand why different cities experience such different rates of growth in this regard!