As we watch medicine unfold, there is a lovely debate emerging around slow versus fast medicine. It would seem that emphasis on the bedside falls very much in the category of the former. This debate also is reminiscent of the work of David Orr and his lovely books, THE NATURE OF DESIGN and DESIGN ON THE EDGE. David’s term was slow knowledge versus fast knowledge.
In his book, The Nature of Design, Orr says, “The modern dilemma is that we find ourselves trapped between the growing cleverness of our science and technology and our seeming incapacity to act wisely.” He differentiates between the two types of knowledge, saying that, “The aim of slow knowledge is resilience, harmony, and the preservation of long-standing patterns that give our lives aesthetic, spiritual and social meaning.”
Fast knowledge, by contrast, operates with the following (false) presumptions: if it can be measured, it is important, and if it can’t, it isn’t; more information is better and there is little distinction between information and knowledge; fast knowledge presumes that if we forget old knowledge, it doesn’t matter since the new knowledge is better; it presumes that mistakes from new knowledge will be solved by more knowledge and, finally, that the acquisition of knowledge has no duty of responsible use.
Fast knowledge in the medical context then represents technology carried to excess, forgetting the patient’s fundamental needs. Slow knowledge, on the other hand, in the way Orr describes it, sounds very much like clinical wisdom, attentiveness to the patient’s story, and to the patient’s body and is the kind of thing we want to develop in our trainees.
Our view is that the best way, and perhaps the only way, to convey our attentiveness, our caring is by our presence and our caring. The careful, time-honored means of the interview and the laying of hands during a thorough physical exam go a long way toward establishing a patient-physician relationship and gaining the patient’s trust. If we want to teach ‘slow knowledge,’ it will be necessary that bedside rounds be at the bedside. We should bring patients to grand rounds and invite them into a dialogue about their situations.