I found that most of the patients could be handled very well on five medications. So I was taking them off between 10 and 15 medications, which, if you figure it out economically, is incredibly cost effective for the extra few hours of time it took me. So I was quite happy there.
And then meanwhile — of course, I’d gone back to study — so this is actually what I call the efficiency of inefficiency. Meanwhile, I’d gone back, as I had decided to do, to get my PhD in medical history with Hildegard of Bingen as my focus. And what I decided to do was to really learn Hildegard’s medicine as if I were its student, by reading her medical text in its original language and by understanding what people were doing around her.
So I took classes and learned Latin because she wrote in Latin. And I learned medieval Latin because she wrote actually in medieval Latin. I learned medieval German and German because that’s what the secondary literature was in. And learned paleography and codicology, so I could actually read the handwritten texts which they had back then.
And I also experimented. Because I figured if I’d been her student in the Middle Ages, I’d sort of have a sense of using her different recipes and prescriptions. So I planted a medieval herb garden. And I brewed up some of her potions and syrups. I tried her medicinal beers. And I baked some of her anti-depressant cookies. And what I found over time, I got more and more interested in the difference between Hildegard’s model of the body and our model of the body because they were clearly very different.
Our model of the body is fundamentally based on the idea that the body is a machine and the doctor is a mechanic, looking for what’s broken and trying to fix it, repair it, or replace it. Hildegard’s model was very different, I gradually learned over the years Hildegard’s model was much more of the body as a plant, rather than as a machine, and the doctor more like a gardener, than a mechanic.
What’s the difference? The difference is that someone has to fix a broken machine. But a plant can heal itself. And Hildegard had a name for the power of a plant to heal itself. She called it “viriditas,” from the Latin “viridis,” that means green. So it was the greening power of a plant to grow, to produce seeds, and to repair itself up when it was injured. And she believed that human beings also have this power. And that the job of the doctor was more to remove what was in the way of the patient’s viriditas and to support it with the basics, than to do something to the patient. So this was a very interesting model.
And it took me years to understand how to apply it to the patients I had at Laguna Honda. But gradually, I began to see that not only could I help a patient by figuring out what diagnosis they actually had, but once I had the diagnosis, to step back and see what was in the way of viriditas and what could I do to support it.
The longer I practiced medicine at Laguna Honda, the more I realized that this was a very helpful way of looking at patients. And I began to think of it as sort of the slow medicine, as opposed to the fast medicine I also used, which was so effective for what I consider fast diseases.
So, for instance, if you come to the hospital because you have appendicitis and you need an appendectomy, or you come to the hospital, and you are having a heart attack and you need an angioplasty, or even if you have cancer, this is when, what I would call by contrast, fast medicine or modern medicine, based on the model of the body as a machine, works great.
But after your appendectomy, and after your angioplasty, and after your chemotherapy, this is when modern medicine, with this idea of coming in, fixing what’s broken, falls down. And what I learned at Laguna Honda is, when I used both models together, first fast and then slow medicine, the patients did the best. They did remarkably well. Many of them were actually able to go home, sort of unexpectedly.
And during the 20 years I practiced medicine, while I was practicing medicine at Laguna Honda, we eventually got discovered and our halcyon days of having enough time began to disappear. And, first by health care efficiency experts, who showed up one day, walking through the place and horrified to discover the aviary, and the greenhouse, and particularly the open wards. And the Department of Justice finally, eventually, showed up and told Laguna Honda that they were going to have to tear the place down and rebuild a new health care facility, that had private rooms for all of the patients, rather than keep the patients on the open wards.
And at that point, I decided to take some time off and write a book about what I’d seen there. That was my first book. And also to think about what I had seen so far in my life as a physician. It seemed to me, when I thought about, that in my life as a physician, the pendulum of health care had swung from the personal to the efficient. And I have been more and more impressed by what that leaves out.
So, for instance, the results of the kind of health care efficiency we’ve had over the last 20 years, as you can see, is that health care costs have kept rising no matter what health care economists have tried to do. They’ve tried to do all kinds of schemes for getting a hold of health care. And this is not true just in the United States, but across the world. Health care costs keep rising every year, despite DRGs and HMOs, and managed health care systems, everything we’ve tried.
Trying to understand what was going on in the system as a whole, I decided to look at Laguna Honda specifically and ask myself, what had gone on there in the last 20 years? So I figured out that in the last 20 years, as a cost-cutting measure, the patients we had, had gone from about 1,178 down to 780. This was as a cost-cutting measure. So we were taking care of a lot fewer patients.
Of course, correspondingly, the number of doctors we had went down, was cut, from 32, to nine. And, correspondingly also, the clinical staff, that’s the nurses, and the therapists, and the social workers, was also cut as a cost-cutting measure, from about 15,000, to 1,200. And yet, at Laguna Honda, every year the budget has increased.